Instrument tracking systems do a lot more than ensure that only properly decontaminated, assembled and sterilized instruments make it back to your ORs. They can track instruments and their locations at any given time, link sets and supplies to procedures and patients, assign already sterile trays to the morning cases and dirty trays to the afternoon cases so surgeons are never left waiting. They can even measure staff productivity.

"We can find individual trays in an instant, including those we share with our sister hospital," says Sara Houston, BSN, RN, CNOR, HN-BC, a staff nurse at Valley Health System in Ridgewood, N.J.

Valley Health's system tracks trays at every reprocessing step and assembly phase, so staff can pinpoint where they are in the process and get an idea of when they'll be ready for the next case.

When surgical techs pull instruments and supplies for procedures, they scan barcodes on a case cart and then scan each instrument tray they place in the cart. The tracking system links the cart and its contents to a patient's identification number, and to the procedure and OR in which it will be used. The system prints out a count sheet that lists every item needed for a case and a label that sticks to the outside of instrument trays. The label notes the name and number of the tray, the case in which it will be used and missing supplies.

Staff can log into the system to determine when and where instruments were used, and on which patients. "That ability to trace back to specific details of instrument use is invaluable when conducting root-cause analyses of post-op infections," says Ms. Houston.

Real-time tracking software is a slick way to manage your instrument inventory, but staff at Valley Health tapped into the technology's full potential when case carts began arriving in central sterile without lids securely attached and with still-soiled instruments haphazardly tossed back into random trays.

Disorganized case carts and improperly cared for instruments are more than just a nuisance. Instruments that aren't wiped down and treated with an enzymatic spray at the point of use are harder to clean before sterilization and more likely to be contaminated when they're returned to the OR. Sharps that aren't strung and trays that aren't properly stacked put techs at risk of a cut finger or broken toe.

"When one of our techs opened a case cart, a tray fell out and just missed her foot," says Nancy Mulligan, BSN, RN, CNOR, a nursing manager at Valley Health System. "She wasn't injured, but she could have easily been."

Members of the health system's OR team weren't returning disorganized case carts because they were lazy or inconsiderate. "They come from various backgrounds and different facilities," says Ms. Houston. "Many were unaware of how we wanted contaminated instruments handled."

Ms. Houston and her colleagues now attach a report card to each case cart on which sterile processing techs assign pass-fail grades to these 5 critical elements:

• Was the cart identified as containing contaminated instruments?
• Was the cart locked and the lid secure?
• Were instruments pre-treated with moisturizing gel?
• Were instruments restacked or restrung, and placed in correct trays?
• Was gross bioburden removed from instruments?

The techs submit the report cards to leadership, who add the daily grades to an Excel spreadsheet and present the findings to the OR team each week. The instrument tracking system links a case cart — and its report card — to the OR in which it was used and the team who sent it to central sterile.