Insights on Instrument Care

You’d be hard pressed to find someone who knows more about proper instrument care than Linda Gomes. The former surgical tech used to work in the sterile processing department of a busy Level I trauma center and is now the central sterile certified lead tech at Lighthouse Surgery Center in Hartford, Conn. The high-volume center specializes in total joint replacements and spine cases — procedures that require large, heavy trays filled with complex instrumentation. “One of the significant challenges surgery centers like ours face is the ability to clean and sterilize instruments efficiently,” says Ms. Gomes.

She recently sat down with Christine Jackson, BSN, RN, the center’s executive director, to discuss how they ensure instruments are properly sterilized and complete the circuit between ORs and sterile processing as quickly as possible.

• Meticulous cleaning. The facility’s reprocessing techs must clean every instrument in every set — no small task when working with the intricate and heavy-duty tools used in orthopedics and spine. “They work extremely hard to remove bioburden, which coats the surfaces of devices if it’s allowed to dry,” says Ms. Jackson. “That’s why it’s imperative that surgical techs treat instruments at the point of use with enzymatic cleaner to prevent bioburden from drying before reprocessing techs have a chance to remove it in decontamination.”

Surgical techs place used instruments within biohazard containers housed in each case cart, so soiled instruments are kept separate from tools that weren’t used during surgery. When carts arrive in decontamination, reprocessing techs know to focus their manual cleaning efforts on the instruments within the biohazard container.

After techs clean soiled instruments, the contents of the entire cart — used and unused tools — are run through a large, automated washer that can clean the contents of an entire cart in about an hour. The cart washer is an unusual feature in the sterile processing department of an independent surgery center. “Without it, our reprocessing techs would work around the clock to keep up with the number of trays we need to reprocess,” says Ms. Jackson.

Cleaned instruments are wrapped in blue wrap or placed in a rigid sterilization container, sterilized and sent back to the ORs. Ms. Gomes cautions that rigid sterilization containers can take up significant storage space, but also points out blue wrap can tear, requiring the contents of the trays to be re-sterilized. It’s a time-consuming hassle that’s best to avoid, if possible.

The current national shortage of blue wrap has also increased the already difficult task of ensuring instruments are reprocessed efficiently and effectively, according to Ms. Jackson. “It’s been difficult to navigate,” she says. “We’ve ended up using more rigid containers and individual peel pouches.”

• Organizing loaner sets. As the two women spoke about the center’s reprocessing practices on a Friday, a vendor rep had dropped off 16 trays for two shoulder replacements scheduled for the following Tuesday. That was an early drop-off, which created its own set of storage challenges for the surgery center. However, it was better than the alternative of waiting until the eleventh hour for reps to drop off trays that need to be reprocessed before the instruments can be used.

Lighthouse Surgery Center established clear expectations that loaner trays must arrive at the facility 24 hours before the case in which they’re needed. It sometimes takes some strong-arming to get reps to comply. “We had to let them know that we would no longer use their instruments if they couldn’t get them to our facility on time,” says Ms. Jackson.

Instead of saddling reprocessing techs with the chore of keeping track of loaner trays, two head nurses take on the responsibility of communicating with vendor reps and coordinating the delivery and pick-up of the tools. Reps can’t simply drop off the instruments and leave; a member of the sterile processing team reviews the contents of each tray to ensure sets are complete and in good working order before signing off on the delivery. “It all comes down to establishing clear expectations and maintaining constant communication with reps,” says Ms. Jackson.

• Constant collaboration. Ms. Gomes is a sterile processing veteran and former surgical tech, giving her a valuable perspective on the importance of proper instrument care. It’s important for each member of the perioperative team to have a similar understanding or, at the very least, an appreciation for how hard reprocessing techs work to clean and sterilize the tools they use. 

Members of the surgical team often wonder why it takes so long for sterilized instruments to be returned to the ORs, while reprocessing techs often feel underappreciated for the time and energy required to properly clean and sterilize instruments. Maintaining clear communication and teamwork between both departments is key to efficient instrument flow.

Ms. Jackson says having members of the surgical team rotate through working in the sterile processing department gives them a true appreciation for how hard reprocessing techs work and how much they do. It also gives them a basic understanding of the job’s responsibilities in the event they need to step in to help. 

“Some surgical professionals don’t think about how sterilized instruments arrive in the OR,” says Ms. Gomes. “When they see firsthand what’s involved, they realize there’s a lot that goes into it.”

When Ms. Gomes worked at the Level I trauma center, members of the surgical team would pass reprocessing techs in the hallway and have no idea who they were. That’s not the case at Lighthouse Surgery Center. The facility’s leadership has emphasized that no individual staff member is more important than another, regardless of their position or level of responsibility.

“We’re all in this together and know we need one another to be successful,” says Ms. Gomes. “When nurses and surgical techs have downtime, they come to our department to help out. Every facility needs that type of team-first attitude.”

Still, it’s the center’s sterile processing staff that makes the place tick. “Without them, no surgeries would happen,” says Ms. Jackson. “They’re the heart of our operation.” OSM

Note: This three-part article series is supported by Healthmark.