Q How should we handle equipment on loan for surgical procedures? Our current policy is that loaner equipment surgeons request must be brought to our facility the day before the procedure for decontamination and sterilization. Our concern is that some of this equipment (because it's very expensive) is being used in several hospitals and surgery centers - wherever the surgeon practices - and we can't be sure that every facility handles and reprocesses as we do. Some have come into our department quite obviously inadequately cleaned after they'd been used. This is a growing problem, as more and more specialty surgeons are using our facility.

A Borrowed devices should go through the same acceptance procedures as newly purchased equipment. Don't deviate from your policies just to appease a visiting surgeon or any other surgeon who has privileges at your facility - management should make the rules clear in advance of granting privileges to any surgeon.

That is something that's easier said than done unless you have a very enlightened management who understand the consequences of using potentially dangerous loaned equipment. It's true that some surgeons have a very cavalier attitude about the care and handling of their equipment and will fight anything that will hold up or delay their surgical procedures. You can only avoid this by having written procedures that you consistently enforce - and that management backs up. For help writing your policy, see "Components of a Loaner Instrument Policy" and visit writeOutLink("www.iahcsmm.com",1) and writeOutLink("www.ashcsp.org",1) for the joint position paper on loaner instrumentation by the International Association of Healthcare Central Service Material Management and the American Society for Healthcare Central Service Professionals.

A sterile item brought into the facility as a single-use, pre-sterilized item is no problem. I wouldn't recommend that you take the item from the package and process it unless the package is clearly damaged. A few surgeons will bring in perfectly good, sterile items and ask you to flash them, unaware that this will probably result in a less safe product. Don't flash any medical device unless you know that it's safe to do so.

You could ask that the physician (or, more likely, the physician's office) provide documentation from the previous user regarding how it cleaned and processed the device. This won't absolve you from your responsibility to provide safe and effective instrumentation. Your lawyer could draft a release form, but he'll probably tell you it's best to follow your written procedures and not deviate except in very rare cases where you can determine the safety and effectiveness of the device without its going through your processing.

Any new equipment should be brought to the attention of staff before it's used; if in doubt, get written processing instructions from the manufacturer before you use any piece of equipment. Finally, and I can't stress this enough, train everyone in your system, as well as your vendor reps, on your policy manual.