Stand-alone Sterile Processing Centers

When designing the expansion at the Hospital of the University of Pennsylvania (HUP) in Philadelphia and planning the new HUP East hospital that will open later this year, Penn Medicine officials discovered a space problem. The health system's current sterile processing setup was already less than optimal, with the instrument decontamination area on the fourth floor of one building and the sterilizers in the basement of another. "We were landlocked and realized that performing sterile processing correctly would require nearly an entire floor of the new building, which would be better used for more space to treat patients," says Chris Pastore, managing director of the new sterile processing facility, known as the Interventional Support Center. "That forced us to look at the potential of an offsite model."

The new 110,000-square-foot instrument care facility opened on Feb. 1 — during a snowstorm and with no weather- or transportation-related delays in deliveries, which are 15-to 30-minute drives, says Mr. Pastore. The facility has the capacity to process instruments from up to 200 surgical cases a day, and currently serves HUP, Pennsylvania Hospital and three affiliated outpatient facilities.

The Ohio State University Wexner Medical Center opened its freestanding facility, the first of its kind in the state, on Feb. 22. The $45.3 million, 62,000-square-foot space has the capacity to process instruments for 48,000 surgical patients per year. It services four hospitals, multiple same-day surgery centers and will reprocess instruments for at least three new surgery centers within three to five years.

In addition to instrument reprocessing, the facility will also prepare and pack supplies for cases. It also has an onsite service to repair, refurbish and maintain instruments, as well as administrative offices, conference rooms and staff changing areas.

Kim Jones, OSU Wexner's director of central sterile supply, says the facility was designed to ensure one-way workflow. "Current operations at many older facilities force you to work around structures that prohibit a one-way flow," she says, "but the linear construction at new freestanding facilities ensure every instrument moves from a dirty area to a clean area."

Some of the keys to the success of the new facility included making sure surgeons' preference cards were accurate, says Ms. Jones, so that an instrument a surgeon would need in an hour or two doesn't wind up on a truck to the offset reprocessing facility. The staff created a list of items that would always stay onsite at the health system's hospitals for reprocessing, such as tools that are used in trauma cases. They also worked closely with OR teams at different hospitals to standardize sets used for cases that are turned over with high frequency.

"Surgery is the moneymaker for most health systems, and central sterile is the lifeblood of surgery," says Ms. Jones. "You're working against the grain if your ORs and central sterile departments don't have a strong sense of partnership, cooperation and teamwork."

Instrument sets needed for early morning cases arrive at least a day before the scheduled procedures in which they'll be used, says Ms. Jones. Transport trucks make runs to or from facilities every two hours. The workflow is easier at the outpatient centers than the hospital settings, as the procedures are scheduled in advance and take place between 7 a.m. and 5 p.m.

"We collect instruments immediately and get them sterilized and ready for re-use the next day," says Ms. Jones. Any item used after 7:30 p.m. stays behind and is processed at the facility itself. Staff members at the offsite reprocessing facility work closely with perioperative leaders, so they know exactly what instruments will be arriving for reprocessing and which need to be shipped back to the ORs.

A single large instrument reprocessing location also makes for maximum efficiency. There are eight sinks in the decontamination area, for example, so multiple techs can clean instruments simultaneously. Transport trucks arrive every four hours, so the techs know what instruments are coming and when they'll arrive. As soon as one of the facility's managers finds out what's arriving on the truck, they assign the appropriate number of techs to the decontamination area. When they're finished in decontam, they de-gown and start assembling clean sets, without any of waiting around. "We basically move our staff to where the work is, and they push the instrument through," says Ms. Jones.

The new facility is a good business model — and a tool for staff satisfaction as well. "The folks that have spent their careers in the basement of hospitals now work in an environment with natural lighting and beautiful surroundings," says Ms. Jones. "You can tell it's enhanced the quality of their work lives just by seeing their faces."

Northwell Health's $80 million reprocessing center on Long Island opened in 2018 at the site of a former popcorn factory that made the snack for movie theaters in the tri-state area. It serves multiple hospitals and outpatient surgery centers in the massive New York health system. The 110,000-square-foot facility processes instruments from 250 to 300 cases a day — about 15 million instruments each year for five hospitals. The facility was built to process 22 million instruments annually over the next several years. It also has on-site technicians who can repair broken instruments and perform preventive maintenance on sets.

Transport workers in trucks pick up instruments in Northwell's hospitals as late as 11 p.m. and deliveries of other batches for the next day's cases starts at 4 a.m. When the instruments for an OR's first case of the day are sterilized and delivered varies. "There's no science to that," says Adam Boll, Northwell's executive director of joint venture operations. "Sometimes the trays may have been there for two days beforehand because it wasn't used. Sometimes the instruments come the night before. Sometimes there may be things that arrive at 4 a.m. for that day."

Regardless of whether you visit the center in the wee hours of the morning or the dead of night, you're guaranteed to find a hub of activity. "We run an intricate, flexible and versatile 24/7 operation," says Mr. Boll. "The reprocessing equipment never stops humming, and our trucks never stop rolling." OSM