THIS WEEK'S ARTICLES
New and Emerging Tech for Sterile Processing
Numerous current and developing tools are poised to boost reprocessing efficiency and quality.
The technologies and solutions both available and in development for techs in today's sterile processing departments (SPDs) are becoming smarter, faster and more advanced every year, positively impacting the working quality and lifespan of surgical instruments while enhancing efficiency at high-volume facilities.
Here are some examples of cutting-edge SPD tools, technologies and future concepts that are exciting SPD leaders.
Even "smarter" instrument tracking. Edwin Martinez, a central sterile processing technician at MacNeal Hospital in Berwyn, Ill., envisions seamless integration of near-field communication (NFC) tracking technology into his SPD. NFC, which is used with hotel key cards and mobile phone payment apps, works at very close range to transfer information between two electronic devices in a contactless manner.
NFC is similar in concept to the radio frequency identification (RFID) and barcode scanning systems already used in some SPDs, enabling staff to know exactly where instrumentation and trays are in real time. Mr. Martinez believes NFC on staffers' personal devices can help make them even more situationally aware. "We already have wireless networks in hospitals, and we keep our phones close to or on us at all times in sterile processing," he says. "The technology is there, someone just needs to implement it in ways that could help us track single instruments, trays and surgical case carts with our phones."
Robotic instrument reprocessing. "My facility added robotic surgical services one year ago, and since the rollout, our sterile processing team has pivoted to learning and following stringent instructions for use (IFUs) for these devices while also working to maintain balanced production flow for the other surgical services our facility offers," says Rebecca Peplau, BS, CSPDT, CRCST, CER, sterile processing educator at Northern Light Mercy Hospital in Portland, Maine. "Due to capital equipment budget constraints, however, we're limited with what we can do since only one of our ultrasonic cleaners can accommodate robotic instrumentation. That leads to a backlog of items waiting to be run through the ultrasonic cleaning process."
"Ultrasonic machines that are specifically designed for robotic arm decontamination and disinfection are a key technology needed for today's frontline medical device reprocessing teams," says Monique Jelks, MSOL, BA, CRCST, area director of sterile processing at The Resource Group & Ascension Health for Indiana and Tennessee. These machines, while available, take up space and require significant capital investment, but they make sense for facilities that perform a high volume of robot-assisted surgeries. "With this type of technology, departments are able to clean and flush complex lumens and thermally disinfect robotic arms in the most efficient ways, creating high reliability and safe surgical care," she says.
AI, VR and AR. University of Louisville (Ky.) Health System Sterile Processing Department Manager Matthew Frederick, CRCST, believes a tidal wave of machine learning including artificial intelligence (AI), augmented reality (AR) and virtual reality (VR) will soon flow into SPDs, enhancing efficiencies and quality. For example, he foresees automated flushing pumps for manual cleaning, and software that identifies missing instruments from a tray with a single photo. He would love to see IFUs through AR glasses to ensure documented steps of reprocessing are accessible to techs whenever and wherever they need them, or AI being used to optimize surgical trays so facilities can better maintain inventory databases.
Mr. Frederick even envisions such innovation in the instruments themselves. "I believe that with more advances in the technology of imaging and 3D printers, our reprocessing teams may start printing single-use instruments instead of sterilizing reusable instruments, thus eliminating the potential for cross-contamination," he says.
"With the growing complexity of surgical procedures being performed in outpatient ORs, more forward-thinking facilities are turning their attention to high-tech reprocessing systems for their surgical instruments," says Hank Balch, CRCST, CER, CIS, CHL, founder and president of Beyond Clean, a clinical education company for sterile processing professionals. "It's more important than ever for facility leaders to have their fingers on the pulse of emerging technologies that improve the dangerous and dirty jobs done by hardworking techs in SPDs. It's no longer a question of if this equipment will be used, it's now a question of when. Will you be ready to invest in the latest platforms when that day arrives?"
Are You Using Too Many Instruments?
Save significant money by eliminating rarely used items.
Is your sterile processing department bogged down with rarely used instruments? UNC REX Healthcare in Raleigh, N.C., recently decided to reduce the number of instruments in their trays and refresh the ones that remained. "We wound up removing nearly 10,350 tools from 40 high-volume trays," notes Surgical Service Materials Manager Gretchen Steelman, BSN, RN, CNOR, MBA. Here are the steps she and her staff took to realize meaningful results.
Track instrument usage. "Focus your attention on trays that contain at least 40 instruments and observe cases in which they're brought to the OR to determine how many of the instruments are used," says Ms. Steelman. Her facility also hired a company that specializes in instrument rationalization to help her and her team collect important data. "The results of the analysis identified instruments in trays that were used less than 20% of the time," she says. "When the project was over, nearly 20% of the instruments from each tray had been removed."
Trial the new sets. Evaluate new tray configurations in the OR and audit the usage of their tools, as you may need to make further adjustments. Be sure that service line coordinators review the final tray configurations before your physicians give their stamp of approval.
Communicate the changes. Make sure your sterile processing department (SPD) is looped into your modifications so reprocessing techs know how to configure the updated sets before sending them to ORs. "To make the transition as smooth as possible, we created a checklist that outlined the responsibilities for each service line coordinator, the instrument liaison from SPD, the preference card coordinator and the materials manager," says Ms. Steelman.
Given ever-increasing cost constraints in health care, finding ways to save money is paramount, and Ms. Steelman found that instrument tray reduction was an untapped resource for savings. "Eliminating rarely used items instead of paying to maintain or replace them saved our facility $530,000," she says. Having successfully reduced the number of instruments for vascular, cardiac and thoracic trays, she and her staff are investigating instrument rationalization for other service lines, with the goal to consolidate additional trays and provide even more cost containment.
Anticipated Growth in ASCs Raises Concerns Over the Impact on Surgical Instrument and Device Performance
Clinical professionals, sterile processing professionals and biomedical engineers are concerned about wear and tear that an increase in procedure volumes will have on the performance of surgical instruments and devices.
Procedural activity in the ambulatory surgery environment continues to increase at healthy growth rates of 6% to 7%.1 Greater than 80% of all surgeries are outpatient surgical procedures performed in one of more than 6,000 Medicare-certified ASCs in the U.S.2 Some of the driving forces behind the shift include 35% to 50% lower costs than in hospitals, growing Medicare reimbursement approvals for procedures and convenience for both patients and physicians.1
Patient safety and successful procedural outcomes are crucial to all ASCs' mission and success in delivering a high standard of care. ASCs drive efficiency through lean operations, quick processing turnaround and maximization of equipment uptime. Although the facilities are smaller and there are fewer staff, meeting compliance and accreditation requirements remains vital to ASC success. Increasing partnerships between ASCs and proven organizations in the healthcare industry provides critical access to education and training for staff without adding to operational costs.
BD (Becton Dickinson) is advancing the world of health™ by partnering with STERIS IMS (Instrument Management Services) to help customers create a HEALTHIER AND SAFER WORLD. This collaboration provides holistic insight to ASCs and builds a foundation for sustainable standards of care during procedural volume increases. Asset management and equipment maintenance are critical elements of safe patient care.
Surgical instruments and devices wear during use and processing. Ensuring optimal performance requires process, commitment and insight. The graph shown here is a representation of the diminishing performance of instruments and the correlation to patient safety and surgeon satisfaction. When usage and time for the instrument and tray increases, the following may occur: instrument performance decreases, surgeon satisfaction decreases and patient safety risk increases. Like tires on a vehicle, the more they are used, the less tread and traction, the higher risk of slipping and potential passenger harm.
Inspection and maintenance of surgical instruments and devices is critical to ensuring optimal performance. Having a well-defined maintenance plan will ensure compliance with 42 CFR 482.41 (d)(2), "Facilities, supplies, and equipment must be maintained to ensure an acceptable level of safety and quality." Additionally, industry guidelines and instructions for use all include inspection and maintenance as the standard practice. ASCs should follow a maintenance strategy determined by their durable inventory, usage history and growth projections as well as evidence-based observations.
ASCs must be mindful of the increasing strain procedural volume can have on equipment performance. Proven industry leaders, such as BD and STERIS IMS, are partnering with ASCs to create maintenance programs and quality solutions to account for the increased strain. BD's V. Mueller™ instrumentation has been developed with first-rate technology and high-quality design to ensure highly successful outcomes for surgeons and patients for more than 120 years. STERIS IMS is the official service provider of V. Mueller instruments and has partnered with BD to provide replacement programs at point of service for healthcare facilities. Well-defined maintenance programs increase efficiencies, optimize inventories and budgets and control costs by reducing preventable damage and severity. Additionally, support through education and hands-on training programs for sterile processing and clinical staff promote the adoption of recommended practices for the care and handling of instruments and devices.
Discover more information on how BD is innovating to drive better outcomes. Please go to go.bd.com/ASC-partner.html
Discover more information on how STERIS IMS keeps your instruments and devices procedure ready. Please go to www.steris-ims.com
1. Van Biesen T, Johnson T. Ambulatory surgery center growth accelerates: is medtech ready? https://www.bain.com/insights/ambulatory-surgery-center-growth-accelerates-is-medtech-ready/. Accessed October 21, 2020.
2. Dyrda L. The number of ASCs in the US: a state-by-state breakdown. https://www.beckersasc.com/asc-news/the-number-of-ascs-in-the-us-a-state-by-state-breakdown.html. Accessed October 21, 2020.
Instrument Cleanliness Should Be Monitored Daily
These four important tools enable reprocessing techs to consistently deliver clean, undamaged instruments to ORs.
Sterile processing department leaders should employ various technologies and devices to ensure instruments are clean and sterile. Here is a look at four of the most frequently used.
Rigid containers. These rugged but specialized containers provide a powerful defense against instruments becoming contaminated after sterilization, while also saving reams of blue wrap as well as space when, as is the case with most such containers, they are stackable. Although they can be heavy, cumbersome to move, require maintenance and require cleaning between uses, sterile processing professionals say the containers are worth the trouble for all of the benefits they provide.
Biological indicators. These tools, required by industry guidelines, can confirm that conditions were met in a sterilizer load to kill the required number of microorganisms. Intended for use as part of daily quality monitoring of your sterilization equipment, the newest versions of these biological indicators can provide results much more quickly than previous generations, usually within minutes. That makes life much easier for busy sterile processing techs, and significantly decreases the amount of time a sterilization load must spend in quarantine.
Chemical indicators. These monitor whether required parameters to achieve sterilization have been met for a specific process, such as hydrogen peroxide or steam sterilization. They undergo a chemical or physical change that makes it easy for techs to see that instruments were exposed to the proper temperature, time and sterilant. "This is a proven way to determine whether instrument sets have been through a proper sterilization process," says Jig Patel, ST, CRCST, CHL, CIS, CER, sterile processing educator and quality manager at UCLA Health in Los Angeles.
Borescopes. These devices allow reprocessing techs to inspect the insides of lumened instruments for bioburden and defects without needing to rely on their naked eyes. Mr. Patel believes they are among the most helpful tools frontline sterile processing technicians have at their disposal. Some IFUs for the ever-more-complex and difficult-to-clean instruments used in today's OR even specify the need for inspection with a borescope at the decontamination or assembly stage of reprocessing.
Mr. Patel insists that his staff devotes time inspecting instruments to ensure they have been properly cared for before they're returned to the ORs. "If an instrument isn't clean, it can never be sterile," he says.
What Can SPDs Learn From the TSA?
At an Iowa hospital, an airport security-style scanning process recovered $35,000 worth of lost instruments over nine months.
When surgical instruments consistently went missing in the main OR at University of Iowa Hospitals & Clinics in Iowa City, a multidisciplinary team sought to pinpoint the source of the issue and correct the problem.
"After working with the many groups that make up the OR team, we determined that some of our instruments, such as drill attachments, glass vials, needles and scissors, were being accidentally thrown away during the OR clean-up process," Nurse Manager Anna Carpenter, MSN, RN, CNOR, tells the system's publication the loop. "Aside from the monetary loss of these instruments, it's also a safety hazard to dispose of these items incorrectly."
Their solution will be familiar to anyone who has ever arrived at an airport to board a flight: using TSA-style technology to scan bags of trash as they come out of the OR and pass through environmental services. The health system's supply chain team had heard about the use of the technology at another hospital and decided to acquire a scanner and set up a similar process for scanning trash.
Now, after the OR team finishes a case and environmental services cleans the room, trash and linens are placed on a conveyor belt and run through a scanner, just like bags at an airport. The trash bags are numbered to identify from which room and surgery they originated. When an instrument is detected, a nurse is called to identify it and process it correctly through the sterile processing department. Each found instrument is documented.
After nine months in use, the scanning process saved the institution approximately $35,000 that would have been spent replacing the instruments that have been found. "This process not only helps with the cost aspect of the missing instruments but is a good safety reminder to the teams that even simple items need to be disposed of correctly," Environmental Services Coordinator Kathie Hankemeier tells the loop. "It's been a really strong team effort to launch this process and make sure that we're being as efficient as possible."
"When you think about some of the instruments we use in certain procedures, they may be one or two of a kind in terms of the supply we have here," says Ms. Carpenter. "If an emergency pops up and we're missing that tool, we'd be hard-pressed to provide the necessary care to that patient. This process and technology allow us to be there for our patients. It's also a reminder to be diligent, follow best practices for disposal of trash and sharps, and to think creatively when confronted with a problem."