June 14, 2023

Instrument Reprocessing and Care

By: Outpatient Surgery Editors

Published: 6/13/2023

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THIS WEEK'S ARTICLES

Keeping Complex Instrumentation Safe and Sound

‘Where Is That Instrument Tray?’

Today’s Evolving TKA/THA Landscape Requires New Solutions - Sponsored Content

Six-Figure Savings Hiding in Plain Sight

Ensuring Endoscopes Are Stored Clean and Dry

 

Keeping Complex Instrumentation Safe and Sound

Rigid sterilization containers can prevent harm to patients, staff and your surgical schedule.

OrtizRon Hester Photography
THE LONG GAME Because rigid containers protect instruments and extend their lifespans better than blue wrap, the future savings they create often exceed their high upfront cost.

If your reprocessing techs handle a high volume of complex instrumentation day in and day out, it’s imperative that they take every measure possible to ensure these expensive tools are both handled correctly and sterilized properly. It’s vital not just to protect patients from harm by limiting the risks of surgical site infections, but also to the surgeons who demand precision and don’t want to find themselves in a situation where an instrument malfunctions or is broken.

To keep instruments safe from harm and to maintain sterility in storage, many surgical facilities and their sterile processing departments (SPDs) have moved on from blue-wrapping instruments by investing in rigid sterilization containers. Hospital for Special Surgery (HSS) in New York is an example of a facility that relies heavily on rigid sterilization containers to keep its instruments secure and sterile.

“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 Richard Ortiz, CRCST, senior director of central sterile processing and durable medical equipment at HSS. “Rigid containers are made of stainless steel or anodized aluminum, which are sturdy materials that won’t easily bend or crack.”

Rigid containers are particularly useful for processing and storing heavy, bulky orthopedic tools that strain and stretch blue wrap, leading to tears and even injuries to staff members who move or handle the trays. Additionally, when these tears occur, precious time is wasted. “Once the blue wrap is punctured, our department is forced to reprocess the tray, which can cause unwanted case delays that a busy surgical facility cannot afford,” notes Ms. Ortiz. “Rigid containers eliminate these concerns because they protect instrument sets much more effectively and consistently than blue wrap and tape do.”

Mr. Ortiz says your case volume will determine how many rigid containers your SPD might need and how long they will last. “The containers require a significant upfront investment but are much more cost effective than blue wrap in the long run,” he says. “For me and my busy staff, the rigid container is always the better and safer option.”

‘Where Is That Instrument Tray?’

Tracking technology can provide an instant answer.

TrackingNorthwell Health
NOT JUST TRACKING Instrument-tracking systems can also help leaders adjust inventory, create efficiency reports and more.

Many surgical facilities rely on instrument-tracking systems that can inform leaders and providers about where an instrument tray is in its reprocessing journey at any given time.

Jig Patel, ST, CRCST, CHL, CIS, CER, sterile processing educator/quality assurance manager for UCLA Health in Los Angeles, says these systems have proven helpful, especially with locating infrequently used trays. “When I communicate with certain folks outside of the sterile processing department (SPD), I can give them a lot of information to sort of pre-answer any of their questions thanks to the instrument-tracking technology,” he says.

Depending on the type of instrument-tracking system used, SPD leaders and technicians can more quickly locate items needed for time-sensitive procedures, adjust inventory management practices by tracking usage of instruments for purchasing, create efficiency reports, and spot maintenance and repair issues.

“We do a ton of transplants, and every 10 uses you want to sharpen the scissors or any cutting instrumentation,” says Mr. Patel. “If a transplant surgeon says, ‘Our instruments are always dull,’ I can easily run the usage report and find out if we’re using the instruments more than anticipated.”

Mr. Patel adds that instrument-tracking systems are also very useful when onboarding new hires in that they enable these fresh faces to perform at peak efficiency as quickly as possible. “If you compare instrument-tracking technology to a paper count sheet, the tracking system will help staff learn more quickly and effectively,” he says. “For example, say you need your new staff to learn certain trays. If you associate photos with each of the individual instruments during training — items they may never have seen before — your new hires are learning the instruments as they go instead of just reading the items off of the count sheet.”

Instrument-tracking technology is generally standard at large health systems, but even small ASCs with razor-thin margins can benefit from them. “I believe this type of system pays for itself in terms of eliminating waste in terms of the time you spend looking for instrumentation,” says Mr. Patel. “You can easily track when the instrument was last scanned and the location, which also adds a safety component.”

Today’s Evolving TKA/THA Landscape Requires New Solutions
Sponsored Content

An innovative alternative to sterile wrap offers efficiency, savings, less waste and gains valuable time for surgeons and their OR teams.

One TrayONE TRAY®

It’s an exciting time for orthopedic surgeons and their OR teams as they take on more cases, qualify more patients for complex surgeries and manage the increased workflow of an evolving landscape. The reprocessing required to keep instruments in top condition and ready for use is always a challenge as OR leaders look for solutions that will help them maintain the best possible environment, provide their patients with a safe surgical journey and develop an efficient business model.

Maximizing the reprocessing of orthopedic devices and instruments can be a game-changer for facilities who are evolving their businesses to incorporate more caseloads. The goal of performing more surgeries in less time is possible with a solution by ONE TRAY®, which offers the ability to do more surgeries in less time while utilizing less trays. That amounts to efficiency and an innovative solution that works for the ASC.

A major benefit of this solution is the need for less storage space, which is important for ASC facilities. Additionally, less overall waste resulting from this solution is a positive for the environment overall.

As an alternative to sterile wrap, the benefits for using ONE TRAY® are clear:

• Faster sterilization

• More Surgeries Less Trays

• Mitigation of holes and wet packs

The actual design of these trays also increases productivity – an important consideration in the outpatient market where delay negatively impacts ROI. The design of ONE TRAY® minimizes dents, nicks and other damage. In fact, this rigid container consists of a base, lid, filter covers and deck plate constructed of anodized aluminum and stainless steel materials. The compression force cam locking design ensures optimal lid to base interface and the cam locking mechanisms on each side lock down the lid to create a compressive forced seal.

Unlike other rigid containers, ONE TRAY® has a curved aluminum lip on the rim of the base that comes in contact with the blue silicon seal on the lid. This addition of strength and durability helps reduce nicks and the added rigidity improves the lid to base interface. The filter covers have silicon SterObex™ technology that presses down on the filter, into the groove and once locked, creates a seal.

The challenges of reprocessing are met as efficiency and durability offer positive outcomes for the surgical team. Reprocessing medical devices in minutes, not hours, is possible with ONE TRAY®. Internal durability testing has demonstrated there was no degradation or functional change when repeatedly reprocessing medical devices within the ONE TRAY® products according to the Instructions for Use.

ONE TRAY®’s Lifetime Warranty. ONE TRAY® Sealed Sterilization Containers are guaranteed for the life of the product to be free of functional defects in workmanship and materials when used normally as recommended for their intended purpose in conjunction with ONE TRAY® filters, tamper evident locks, and deck plate. Any product determined to be defective after normal usage will be repaired or replaced with no charge to the customer.

The ONE TRAY® solution is efficient, effective and economical – all adding up to an innovative solution for today’s growing orthopedic market.

Please follow the ONE TRAY® IFU for use.

Note: For more information or to contact ONE TRAY® go to: onetray.com/contact

To see a LIVE case timelapse showing ONE TRAY®/EZ-TRAX™ vs sterile wrap, please go to https://www.youtube.com/watch?v=xflI4mDGWyg&t=59s

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Six-Figure Savings Hiding in Plain Sight

One simple decision was a cost-cutting epiphany for this facility.

When leaders at AdventHealth in Sebring, Fla., saw expenses were out of order compared to its surgical case volume, they decided to take a deep dive to find out what was wrong. Debra Callender, DNP, RN, CNOR, CSSM, administrative director of surgical and orthopedic services, quickly learned she could save her facility six figures per year without sacrificing patient safety through one simple, low-impact decision.

It turned out the nine-OR facility, which averages 50 surgeries each day, was spending more than $100,000 annually on plastic instrument covers that were used to transport tools from its ORs to its sterile processing department (SPD). AdventHealth was able to ditch that expense because Dr. Callender identified something that would work even better that was already in-house.

“I decided to test out the effectiveness of using the back table drapes that are already included in our surgical packs to wrap and completely enclose decontaminated instruments and seal the packages with a biohazard sticker,” says Dr. Callender. Once the wrapped trays arrive in SPD, techs can simply throw the single-use drapes away.

This one simple decision led to significant savings. By using something that was already on its shelves, Dr. Callender estimates AdventHealth saved $80,000 annually in supply costs and $60,000 per year in instrument replacement and repair.

While the truth of the matter is that you’ll rarely, if ever, identify an opportunity to achieve such significant savings from a single inexpensive intervention, Dr. Callender’s success story should inspire all facilities to identify inefficiencies and find savings at the margins. Costs can be controlled by keeping a keen eye on the smallest of expenses.

“Don’t ever think something is too small to make a substantial difference in your facility’s budget,” says Dr. Callender. “You might be surprised by what you find.”

Ensuring Endoscopes Are Stored Clean and Dry

Here’s a quick overview of your storage cabinet options.

When it comes to patient safety, it’s not enough to high-level disinfect or sterilize your endoscopes. At the end of the reprocessing cycle, clean scopes must also be dry. In fact, the most recent update to the AAMI ST91 endoscope reprocessing standard states that all endoscopes should be dried with forced filtered air for 10 minutes through all channels before going into storage, where they must remain dry while awaiting their next use.

“Residual moisture in and around endoscopes promotes the growth of organisms and increases the risk of infectious outbreaks,” says Kavel Visrodia, MD, assistant professor of medicine in the Division of Digestive and Liver Diseases at Columbia University Irving Medical Center in New York. “As a result, the storage cabinets in which reprocessed scopes reside until their next case have come under increased scrutiny.”

Today’s endoscope storage cabinets approach the drying issue using a variety of methods:

  • Passive. The cabinet is ventilated, but no airflow is being actively directed through the cabinet.
  • Active. Filtered air is circulated throughout the cabinet, but not through the channels of the endoscopes.
  • Forced-air systems. A built-in or external system delivers pressure-regulated filtered air through attachments that connect directly to each scope’s channels, which could reduce the risk of incomplete drying.

“There remains a relative lack of high-level, evidence-based data that compares these three types of systems with endoscope contamination,” says Dr. Visrodia. “Generally, all three remain effective options for storage based on available guidelines, but endoscopes always should be stored per their manufacturer’s instructions.”

When evaluating your various cabinet options, also keep the size and capacity of the cabinet in mind. “After determining the type of storage system you want, examine the spatial footprint of the cabinet and make sure you have the space needed to accommodate it in a dedicated area,” says Dr. Visrodia. “Additionally, see if the number of scopes the cabinet can safely store in the proper fashion — meaning that at full capacity, no scopes touch each other — syncs well with your fleet size and workflow.”

Some cabinets include “smart” capabilities, such as the ability to electronically log how long a scope has been hanging and inform staff that it needs to be reprocessed because its “shelf life” expired; RFID tracking to track the location of a scope; and automated drying times on forced-air drying systems. Another aspect to investigate is if the cabinet offers security features your facility may require, from a simple lock-and-key to an electronic security system that only provides access to authorized personnel. “Keep in mind, however, that your cabinet’s security system should provide authorized users with relatively easy access to the scopes inside, considering those providers will probably be storing and retrieving scopes several times a day,” notes Dr. Visrodia, who warns that as you add more advanced capabilities to a cabinet, the cost will rise.

“Each endoscopy unit will need to weigh the available options carefully and ultimately determine which system best fits their needs, allowing for safe and efficient patient care,” says Dr. Visrodia. OSM

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