THIS WEEK'S ARTICLES
The Value of Sterilization Containers for Endoscopy Equipment - Sponsored Content
Sterilization Containers Are the Smart Choice
Eliminating blue wrap from the reprocessing equation leads to greater efficiencies and improved instrument care.
Wrapping instruments in blue wrap might not be the best choice when your sterile processing department is responsible for turning around a high-volume of tools on a daily basis.
Richard Ortiz, CRCST, sterile processing manager at Stanford University Medical Center in Redwood City, Calif., is in charge of making sure more than 1,500 trays are reprocessed and returned to ORs quickly and safely. He relies on rigid sterilization containers to make sure instruments and flexible endoscopes are cared for properly and protected from inadvertent damage.
Rigid containers are made of stainless steel or anodized aluminum, which are sturdy materials that won’t easily bend or crack. They can also be stacked two at a time. “Ask any sterile processing director and they will tell you there never seems to be enough room to store instrument trays,” says Mr. Ortiz. “That’s why we need to be smart in order to maximize every inch of shelf space.”
Placing instruments in sterilization containers also avoids the cascade of complications caused when tools or devices puncture blue wrap. When this occurs, the instruments in the wrapped tray must be resterilized and rewrapped, time-consuming steps that slow down a busy day of surgery. “If used correctly, rigid containers protect instrument sets much more effectively and consistently than blue wrap and tape do,” says Mr. Ortiz.
Although industry experts differ on the expected lifespans of rigid containers, Mr. Ortiz says well-maintained containers can last for many years. “Every facility is different, and it all comes down to case volume, but we can use a single container six times in one day if necessary,” he says. “The containers require a significant upfront investment but are much more cost-effective than blue wrap in the long run. For me and my busy staff, the rigid container is always the best and safest option.”
A Foundational Approach to High-Volume Caseloads
A renewed focus on the six areas of endoscope reprocessing will get you through your busiest days.
There’s no secret to keeping patients safe while providing potentially lifesaving colonoscopies. The higher the volume a scope center has, the more it should double down on following the standard rules within the six commandments of endoscope reprocessing.
“Changing or modifying any of these essential steps to proper endoscope care will do more harm than good,” notes Casey Czarnowski, former clinical educator in sterile reprocessing practices at Stanford Health Care in San Francisco. “The six basic steps should apply no matter how busy your facility gets.”
Bedside care. Point-of-use precleaning consists of flushing a scope's channels and wiping off the exterior of the insertion tube immediately after exams are complete and before the scope is transported to the reprocessing area. Preassembled kits containing a syringe, basin, sponge and soap make this quick and easy.
Safe transport. Scopes are fragile and expensive. Rigid containers with high sidewalls safely hold them in place as they are brought to the reprocessing area. Federal regulations require containers to be labeled as carrying biohazardous material to alert staff that they contain soiled instruments. “Make sure the containers are made of a sturdy, puncture-resistant plastic, are large enough for the instruments to lie in without the tubes crimping, and high enough on the sides to keep coiled scopes fully contained,” says Mr. Czarnowski.
Leak testing. When scopes arrive at the reprocessing area, leak test the scopes with either a dry or wet leak tester, following the tester manufacturer's instructions for use.
Manual cleaning and flushing. Once the scopes have passed the leak tests, brush the narrow channels within the scope with the proper size brushes designed to accompany each scope and scrub the entire device, including valves and buttons set in all positions. After manual brushing is complete, connect scopes to an automated cleaner that flushes channels with enzymatic soap and/or a high-level disinfectant.
High-level disinfection. Place the scopes in an automatic endoscope reprocessor, which runs them though several cycles of cleaning, disinfecting, rinsing and alcohol flushes. This can take up to 45 minutes to complete. The alcohol flush is important, as it dries internal channels before scopes are moved to the storage area. Examining scopes with a small-diameter borescope after high-level disinfection is recommended to check the scopes’ lumens for residual bacteria.
Proper storage. To maximize drying and minimize the chance of recontamination, hang scopes vertically in storage cabinets that circulate air throughout the storage chamber to help keep scopes dry between uses. High-end cabinets provide a continuous flow of air around endoscopes and feature tubing connectors that blow a steady stream of filtered air through the channels.
Staff should be trained in how to clean all scopes, and one member should be assigned to keep abreast of any new reprocessing developments. “Rely on these sound practices to make sure your patients are treated effectively and safely,” says Mr. Czarnowski.
The Value of Sterilization Containers for Endoscopy Equipment
No-wrap containers are viable, cost-efficient alternatives for protecting instruments as they go through the sterilization process, transport and storage.
Today, healthcare facilities are confronted with escalating costs, unwanted waste and mounting compliance concerns in their Sterile Processing Departments (SPDs). Many hospitals and outpatient facilities that employ highly sophisticated KARL STORZ products, for example, are using sterilization trays that are outdated and costly. Furthermore, many are using trays in sterilization modalities that have not been cleared or validated for the products housed inside.
As part of the safe patient journey, surgical instruments go through decontamination and sterilization. Prior to sterilization, instruments are enclosed in a single-use, disposable polypropylene cloth, traditionally called blue wrap, which prevents entry of microbes and potential contamination. Disposable blue wrap presents a significant burden to hospitals and outpatient facilities in terms of cost, waste and operational efficiency.
KARL STORZ no-wrap containers are a superior alternative to sterilizing and protecting KARL STORZ products. The sterilization containers are a simple yet effective system for protection of endoscopic equipment and instrumentation during sterilization, transport and storage. Custom designed to accommodate KARL STORZ endoscopes, camera heads and instruments, KARL STORZ containers have been validated for a variety of sterilization modalities, including high-and low-temperature systems (e.g., autoclave, STERRAD, V-Pro maX).1 Available in a multitude of sizes and configurations, KARL STORZ sterilization containers have applications for many surgical specialties, including but not limited to: Neurosurgery, ENT, Laparoscopy, Urology and Pediatric surgery.
Each KARL STORZ sterilization container includes a container base and lid with an integrated filtration system and silicone gasket to ensure a secure seal, as well as custom basket trays with silicone holders for instrumentation and accessories. Containers are available with single- or multi-layered basket trays, depending on the application. Basket trays for each container are pre-assembled with a combination of silicone brackets, holders and inserts that are securely fixed to the tray, with thoughtful consideration to the intended load of the container.
KARL STORZ sterilization containers are reusable systems that require the use of disposable accessories for each cycle, including filters, process indicator and tamper-evident seal. However, the disposable costs associated with KARL STORZ are minimal in comparison to the disposable costs associated with blue wrap sterilization. All containers feature an integrated filtration system where single-use filters are placed. Filter retention plates secure the filters in place, and vents are offset to reduce the risk of puncturing the filter and compromising sterility.
Prior to sterilization, a single-use bio indicator card is placed on the outside of the loaded container and a single-use tamper evident seal is placed onto the latch of the container. When the cycle is complete, markers on the bio indicators indicate whether the loaded container was exposed to sterilant or not.
Available in a variety of colors that correspond to methods of sterilization, seals are used to inform the next user whether the container had been opened at any point during storage. Additionally, disposable accessories are available after market, and differentiated by container type and sterilization modality.
KARL STORZ sterilization containers offer significant cost avoidance to healthcare facilities currently using traditional, blue wrap trays. Although blue wrap trays have a lower upfront cost, there are ongoing costs associated with use of blue wrap that are avoided by conversion to KARL STORZ sterilization containers, such as cost of re-wrap due to improper care and handling (e.g., tears).
According to a white paper study, a large health system conducted a study to evaluate the cost avoidance captured at their facility over a 3-year period by converting 25 traditional blue wrap trays to 25 KARL STORZ sterilization containers for use with their existing inventory of KARL STORZ camera heads. Comparing the total per-wrap costs of the blue wrap option vs. the total per-cycle costs of KARL STORZ sterilization, the study discovered a cost avoidance of $5.86 for each use of a KARL STORZ sterilization container. Based on early findings of the study, it is projected that the health system will realize a total cost avoidance of over $29,000 during the 3-year study period. Following their conversion to KARL STORZ sterilization containers, the organization expects to realize a return on its investment after just 14 months of use.
1. STERRAD, NX, 100NX are registered trademarks of Advanced Sterilization Products. V-Pro is a registered trademark and V-Pro maX is a registered trademark of Steris Corp.
Note: For more information go to www.karlstorz.com.
Five Variables to Consider When Buying Rigid Containers
Before you decide, make sure you’ve accounted for all of these.
Not all rigid containers are created equal, says Nancy Chobin, president of Sterile Processing University in Lebanon, N.J. Here are five factors to consider when evaluating these innovative but complex products.
Specs. Don’t get dazzled by flashy brochures that often don't paint the entire picture of a container's usefulness, says Ms. Chobin. “Get technical data from vendors and hold them accountable to the instructions for use (IFU),” she says. “The onus is on you to read through the technical data of each container carefully, and understand whether you can actually use it for the instruments you need to reprocess.”
Check the container's validated cycles and ensure they were properly tested and FDA approved for the cycles your facility needs to run. “You don't want to purchase containers and then find your facility uses instruments that require sterilization at temperatures the containers can't handle,” says Ms. Chobin. Also check if the container has been validated to hold silicone mats, surgical towels, lumens or power equipment.
Inserts and accessories. The container should match the instrumentation and devices you use regularly. “For example, expensive, delicate video cameras need to be placed in specialty containers with sprockets that keep the camera and its cable secured so they aren't damaged while the container is moved,” says Ms. Chobin. “Many vendors offer specialty-specific trays and inserts that help you line up and organize the instruments, cords and cables.”
Ease of use. Both OR staff members and sterile processing technicians should sign off on any containers you purchase. Ms. Chobin provides examples of why: “How easy is it for surgical team members to open a container and remove the contents aseptically? Can sterile processing techs easily disassemble the components, remove filter plates and clean them between uses?”
Cleaning requirements. Containers must be disassembled, filter plates removed and internal components washed between each use. “Refer to the IFU for information on proper cleaning methods, which typically involve treatment with a neutral pH detergent and water,” says Ms. Chobin. “This can be done manually or in an automatic washer, so consider how much workload and time are involved in cleaning each container.”
Instrument identification. If you plan to use instrument identification tags on inside baskets placed within the container or on the outside of the container, make sure they are durable and easy to read. Also determine the time it will take to get replacements from the container company if the tags become dislodged, lost or damaged.
Ms. Chobin adds that if your budget is limited, start with containers for delicate and high-expense items that you most need to protect from damage, and ask vendors about payment plans and other ways to reduce the upfront cost.
Four Advantages of Rigid Sterilization Containers
Combined, these valuable positives could justify your facility’s investment.
At Mount Sinai West in New York City, rigid sterilization containers have enabled its sterile processing department to run more smoothly and efficiently. “After performing a true cost comparison of rigid containers and blue wrap, and factoring in other benefits like storage, strength and the environmental impact, you’ll likely find that rigid containers best blue wrap in almost every way,” says William DeLuca, CRCST, CHL, CIS I, director of Mount Sinai West’s sterile processing department.
Here are four reasons why Mr. DeLuca and his team, and by extension the entire surgical staff, rely on rigid containers to keep the department humming.
Time and space savings. The facility reprocesses around 400 instrument trays each day, and storage space is valuable. “You can’t stack trays wrapped in blue wrap because of the risk of holes forming,” says Mr. DeLuca. “Rigid containers are solid and stackable, so this isn’t a concern. Plus, when you’re assembling instrument sets for sterilization, they can be placed in any appropriately-sized container. You just grab one that’s available and get to work.” Meanwhile, time spent applying blue wrap for instruments that now use the containers has been eliminated.
Easier transport. “It’s easier to lift and transport a rigid container filled with 30 pounds of instruments than it is to move a tray of wrapped instruments that weighs the same amount,” says Mr. DeLuca. “Wrapped instrument trays are various shapes and sizes, making it difficult to carry the packages. Rigid containers have two handles, one on each side, making them easier to carry. The containers are also sturdy, so reprocessing techs don’t need to worry that bumps and knocks that occur during transport and storage will contaminate or damage instruments.”
Enhanced sustainability. Blue wrap accounts for close to 20% of all OR waste, according to Practice Greenhealth. Reusable rigid containers allow facilities to greatly reduce blue wrap expenses, as well as the time spent following its related multi-step recycling process. “Properly maintained containers should last at least seven years before they need to be replaced,” says Mr. DeLuca.
Value. “One aspect of rigid containers that leaders balk at is the upfront costs of adding them to their inventory,” says Mr. DeLuca. “A bit of number crunching suggests that concern is likely unfounded. The more you save by investing in rigid containers, the more money your facility will have to invest in higher-quality care.”
Mr. DeLuca advises considering rigid containers as long-term purchases that will pay dividends throughout their long lifespan, and not fixating on the high upfront cost.