May 17, 2023

Right-size your instrument rotation to reduce waste, lighten staff’s load and save money.

ELIMINATE WASTE Reducing the number of instruments that must be reprocessed by removing little-used tools from your trays can enhance the efficiency of your service lines.

When surgeons and nurses with UNC REX Healthcare in Raleigh, N.C., expressed concerns about instrument quality, surgical service materials manager Gretchen Steelman, BSN, RN, CNOR, MBA, sought to identify root causes of the problem. Ultimately, she and her team “right-sized” the number of instruments in rotation.

“After deciding to reduce the number of instruments in our trays and refresh the ones that remained, we wound up removing nearly 10,350 tools from 40 high-volume trays,” she says. “Eliminating rarely used items instead of paying to maintain or replace them saved our facility $530,000.” Smaller additional time and money savings were realized by not reprocessing little-used instruments, as well as decreasing the amount of space needed to store sterilized trays.

Ms. Steelman recommends surgical facilities track instrument usage to identify waste. “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,” she says. Her analysis, performed with the help of a consultant and software that employs advanced analytics, identified instruments that were used less than 20% of the time, leading to the removal of nearly 20% of the instruments from each tray.

“This analytical approach is far superior to relying on perceptions or opinions to determine which instruments should stay or go,” she says, adding that access to hard usage data helped convince surgeons to remove some rarely used tools they had previously insisted upon.

After reviewing results of the data-driven analysis with service coordinators from each surgical specialty, newly optimized tray configurations were created and then trialed in the OR, where usage was audited and adjustments made as needed. “Have service line coordinators review the final tray configurations before physician champions give the changes their stamp of approval,” says Ms. Steelman.

This process can be challenging, involving much back-and-forth before consensus is reached. “Getting numerous surgeons, each of whom has preferences for different instruments, to agree is one of the biggest challenges when it comes to standardizing trays,” says Ms. Steelman, who says physician champions who embrace the changes can help convince their colleagues to compromise.

Once changes were finalized, Ms. Steelman communicated the contents of the new trays with the sterile processing department (SPD) so techs could properly configure the updated sets before sending them back 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,” she says.

The rationalization of the instrument trays produced multiple additional benefits, including repurposing instruments for use elsewhere in the health system, decreased back table setup times, and lighter trays for techs to transport between the ORs and SPD. Additionally, perioperative nurses appreciated not needing to count and prepare ultimately unused instruments.

“Given the increasing cost constraints in health care, we found that instrument tray reduction was an untapped resource for savings,” says Ms. Steelman.

These tests can show your reprocessing staff what they might be missing.

Northwell Health
ADDED ASSURANCE Cleanliness verification tools like ATP tests can help your techs check for vulnerabilities in your reprocessing system.

Your reprocessing staff works hard to ensure your surgical instruments are clean, sterile and safe to use on every patient. But despite their best efforts, there can be biomaterials they don’t or can’t see on instruments, especially with devices like endoscopes that have internal channels. Adding to the problem is that in some facilities, reprocessing staff may feel rushed to turn around instruments to meet high patient volumes, and not do as deliberate or thorough a job.

“Even after washing and disinfecting, it is difficult to verify cleanliness when the primary means of verification is the naked eye,” says Densley Coke, MBA, BSHM, CST, CRCST, CHL, CER, central sterile processing manager for Northside Hospital-Forsythe in Cumming, Ga., and a director on the Board of the Healthcare Sterile Processing Association (HSPA).

That’s where cleanliness verification tools like the following can prove illuminating.

Lighted magnification. Monique L. Jelks, MSOL, BA, CRCST, clinical educator, sterile processing, with WellStar Health’s Cobb, Vinings, Paulding and Douglas Hospitals in Georgia, and incoming president of HSPA’s Board of Directors, says outpatient surgery facilities at the very least should invest in large, lighted magnifiers for the assembly station in the sterile processing department (SPD) where final inspection of instruments takes place. “The lighted magnifier allows the technician to critically inspect areas of the surgical instrument that cannot be seen with the naked eye, confirming its cleanliness,” she says.

Adenosine triphosphate (ATP) testing. Various brands of tests are available that use microbial culture swab assessment, which can detect residual blood or protein that remains on instruments after cleaning. “These kits are disposed of after use and, in most cases, don’t require refrigeration or costly equipment,” says Mr. Coke.

Borescopes. While more expensive than ATP testing and lighted magnifiers, these semi-rigid fiber optic devices better enable techs to inspect instruments with internal channels. “Technicians can use borescopes to look into small cavities and spaces of surgical instruments, where one can find post-sterilization biological remains such as blood, bone, tissue and rust, as well as damage to instruments that was unable to be detected otherwise.” The use of a borescope is now recommended by the updated ANSI/AAMI ST91 endoscope reprocessing standard, and increasingly Instructions for Use for various instruments beyond endoscopes, such as arthroscopy shavers, require their use.

Water quality testing. SPDs should perform tests to ensure water quality and temperature are aligned with detergent manufacturer IFUs. “A water quality test would surprise most administrators,” says Ms. Jelks. “It will confirm the presence of hard water, which prevents detergents from breaking down contaminants. If poor water quality is discovered, there could be a huge cost associated with obtaining a filtration system.”

Damien Berg, BS, BA, CRCST, AAMIF, HSPA’s vice president of strategic initiatives, says ASC leaders should not focus exclusively on these and other verification products and systems such as instrument tracking systems, however. “The first approach I would take would be to verify your policies and practices around decontamination,” he says. “Train your team and then test using different products and methods that will show that the team and equipment are doing what they need to do for patient safety.”

Instrument tray management with a sealed container and innovations in sterilization offer efficiency and cost control.

ONE TRAY^®
Dr. Marchand showing an example of one case, in ONE TRAY^® vs Sterile Wrap.

Orthopedic ambulatory centers have been seeing a rise in case volume for a number of years now as more procedures are moving to the ambulatory environment. The hard work of managing these cases falls on the entire OR team as challenges of efficiency, cost and waste arise. While there have been different approaches to combat inefficiencies and waste, the focus on instrument management and sterilization are front and center in the discussion of how best to utilize the staff and resources available and keep patients safe on their surgical journey.

According to an article in Surgical Technology International, “Surgical Tray Optimization and Efficiency: The Impact of a Novel Sealed Sterile Container and Instrument Tray Technology,”¹ the authors point out that “Approaches to increase efficiencies in the OR have included patient-specific instrumentation, single-use instrumentation, and simple surgeon initiatives to remove unused instrumentation from surgical trays.”^2-4

While how to handle redundant instruments may seem like a simple task as part of the process to increase efficiency, it has proven to be a unique challenge in ambulatory centers. Additionally, room turnover time and the number of trays that must be processed following a procedure also both pose additional challenges for the OR teams.

With a focus on investigating the impact of novel, sealed-container and instrument-tray technology on turnover and costs, the article highlights an important study that compared vendor trays that were blue wrapped and optimized sealed container-sterilized trays (ONE TRAY^®), specifically for a TKA surgical procedure. The study investigated the setup and clean-down time in the OR, the processing time in central sterile supply, and the estimated costs and waste for two different scenarios. These two options include the traditional “blue wrap” tray and the optimized trays that were sealed container-sterilized.

According to the study, “Overall, the use of optimized trays and sealed sterilization containers reduced the turnover time by 57 minutes and the number of trays by a mean of three. OR and CS processing yearly savings were estimated to be $249,245. Waste disposal was an estimated 10,590 ounces and 450 ounces for traditional and sealed containers, respectively.”¹

Furthermore, the study concluded that novel sealed sterilization containers demonstrated increased efficiency in the total turnover time of TKA trays. The authors noted, “This is important for surgeons participating in bundle payments who perform surgery in a hospital and ambulatory surgery center. Reduced turnover time could potentially increase case load and decrease the need for extra instrumentation or loaner trays. This simple means of increasing efficiency could be used as a model for surgeons wishing to streamline surgical trays and reduce costs.”¹

Maximizing the reprocessing of orthopedic devices and instruments can be a game-changer for facilities who are evolving their businesses to incorporate more caseloads. ONE TRAY^® is an American made, Lifetime Warranted sealed sterilization container offering efficient instrument reprocessing in a fraction of the time it takes sterile wrap or other rigid containers. The company offers ambulatory facilities with the opportunity to mitigate delays caused by sterile wrap tears or wet packs as well as experience time and cost savings across multiple departments. The ONE TRAY^® solution is efficient, effective and economical – and it will provide a gas pedal for surgery for the growing orthopedic market.

Please follow the ONE TRAY^® IFU for use.
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Note: To read the full study click here.

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

Please follow the product IFU’s for use.

References:

1. Marchand, Taylor, Salem, Mont, Marchand, Surgical Tray Optimization and Efficiency: The Impact of a Novel Sealed Sterile Container and Instrument Tray Technology, Surgical Technology International, Volume 37: Nov. 2020

2. Watters TS, Mather RC, Browne JA, et al. Analysis of procedure-related costs and proposed benefits of using patient-specific approach in total knee arthroplasty. J Surg Orthop Adv 2011;20(2):112–6.

3. Siegel GW, Patel NN, Milshteyn MA, et al. Cost analysis and surgical site infection rates in total knee arthroplasty comparing traditional vs. single-use instrumentation. J Arthroplasty 2015;30(12):2271–4.

4. Capra R, Bini SA, Bowden DE, et al. Implementing a perioperative efficiency initiative for orthopedic surgery instrumentation at an academic center: A comparative before-and-after study. Med (United States) 2019;98(7).