FAST PACED With up to 12 trays open at any given time, the sterile processing department at DISC has its hands full.

In our facility, because we do a lot of spine, implants are coming and going all the time, and we want to know what trays are being used. Not just "a spine tray," but "Tray X that was processed in Load Y on this date." Anybody should be able to pick up a tracking card and locate any instrument in our facility. We decided, as a team, on the most logical way to label the trays — a way that wouldn't slow down SPD, and that would make it easy for the nurses to see and record the information.

Tracking starts in SPD, where staff document tray name, load number and date. For the circulating nurse, there's a "surgical trays" section on every patient's post-procedure assessment/evaluation documentation. So, for example, in this section you might see "Manufacturer Brand #3," "Carpal Tunnel #3" and "Ortho Minor #2" trays next to stickers verifying the loads — Load #3 (processed April 13), #2 (April 8) and #5 (April 5), respectively — of those trays.

We can have up to 12 trays open at any given time, so the circulating nurse is the one documenting which trays are on the field and on which patients their contents are being used. After we raised our sterilization game, I started auditing the book of tracking logs, making sure I could open it and find out exactly where instruments were and how often they were rotating through.

I also started asking staff to find things on the fly. Using the last case of the day as an example, I'll ask the circulating nurse to find in the tracking log the load an implant came from, then I'll check the patient's chart to see that everything has been recorded correctly — or ask the operative nurse and check against the tracking log. The idea is to verify that everyone is consistently tracking correctly.

Because of the volume of implants and instruments, often specialized, moving through our facility, a tracking process such as this is crucial. If ever there were to be an infection (we've never had one, so knock wood), we'd be able to pinpoint the day, load number and tray the surgical instruments came from. This would let us follow up with other patients whose instruments may have been in the same load or sterilized on the same day. Other benefits: Your instruments will be much better organized, and you'll quickly see if you need to buy more (or retire some) as case volumes shift.

Verifying in SPD
In addition to starting the tracking and documentation process in SPD, we want to verify that we're doing 3 other things correctly.

• Washing processes. Getting a grip on washing means ensuring that water temperature, amount of enzymatic solution and washing procedures are all correct. We take water temperatures before washing begins. There's a line in the sink that corresponds to the precise volume of water needed to accommodate 1 pump of the enzymatic. And washing recommendations are easily accessible for each of our instruments that requires specialized treatment.

• Temperature inside the autoclave. If the autoclave doesn't reach the correct internal temperature during a cycle, or that heat doesn't get into the trays loaded into the sterilizer, your instruments are compromised. Like everyone else, we use biologic and chemical indicators to verify that sterilization has occurred. We also document the results for every load for every sterilizer. For example, for sterilizer 1, the daily record will show the results for 4 loads. We record the type of indicator and its results, along with the contents of each load (for example, "Spine Tray #2," "Carpal Tunnel #3XL" and "Anterior Cervical #2"). The SPD logs this information and signs off with their initials after each sterilizer load.

This lets us create a day-by-day verification record for every sterilizer that cross-references load numbers and tray types. In addition, if we see an uptick in flash cycles or earlier-than-planned releases of instruments, I'll see that as part of my monthly review of the record. That indicates that we need to address an issue in either SPD or the OR.

• Manufacturer specifications. I'm not sure whether instruments are less standardized these days or whether the industry as a whole is more aware of the ins and outs of sterile processing, but it seems as if a lot more instruments deviate from the usual. To help SPD get it right and keep instruments flowing, we have cheat sheets taped to each sterilizer. Here's an example:

There are 6 such cycles, and SPD staff can say either, "OK, what trays do I need for Cycle #1?" or "What do I do with this tray?" and find the answer.

Monitoring outside instruments
Implants and special instruments that come in at the last minute for trialing or on loan threaten sterility assurance. Because of the cutting-edge research our surgeons are involved in, our facility participates in a lot of manufacturers' trials. We're happy to advance a surgery — but not at the expense of sterile processes. We've set ground rules that all reps must sign on to if they want to even set foot in our facility:

• All implant trays must be complete and delivered before 10 a.m., 2 days before the case (on Thursday for a Monday case).

• Reps must be present for every surgery in which their equipment is being used, and they must clean their trays before leaving the facility. This is partly an infection-control issue — reps are the best-trained people to handle equipment that would be unfamiliar to our sterile processing techs — and partly insurance against being blamed for lost or missing parts.

Looking forward, I'd love to get better monitoring tools. I'm trialing some spot-checkers that can show how thoroughly our instruments are being washed — sort of in the same vein as bioburden swabs for surface disinfection. It'd be nice to be able to swipe over the nooks and crannies, or flush a lumen, and verify that instruments are ready for the sterilizer.

TECHNOLOGY UPDATE
What's New in Sterilization

Here are 4 new or recently updated products that can help your facility's sterile processing department work more efficiently than ever.

3M
Attest Super Rapid Readout Biological Indicators
go.3m.com/needforspeed
Get steam sterilization biological results quickly with these indicators and challenge packs. Confirmation of sterilization can be had up to 3 times faster when used in conjunction with the new 3M Attest Auto-Reader 490. Pre-vacuum results are provided in 1 hour and gravity results in 30 minutes. Auto-Reader connectivity is available with some instrument tracking systems.

Advanced Sterilization Products
Sterrad 100NX System
aspjj.com/us
An upgrade kit lets you add a new cycle to the Sterrad 100NX System. The new Duo cycle lets facilities terminally sterilize flexible endoscopes and cameras together, in just 60 minutes. Existing Sterrad 100NX Systems, which provide advanced hydrogen peroxide gas plasma sterilization, already allow 24- to 47-minute cycles for a variety of surgical instruments. The Sterrad 100NX System is an expandable platform that can be upgraded as facilities' needs change, says the company.

Skytron
Integrity 215/215SG Steam Sterilizer
skytron.us
This steam sterilizer can sterilize up to twice the content of similarly sized models and can be used as either an immediate-use or post-procedure, large-capacity sterilizer. With a 21 ?" x 21 ?" x 38" sterilization chamber, it's been validated to process up to 6 25-pound instrument trays or packages in 1 prevacuum cycle. Features such as an integrated water reservoir, internal recirculation system and full-steam jacket ensure consistent water supply/conservation, consistent temperature and ease of use.

Steris
Amsco V-Pro Max Low Temperature Sterilization System
tinyurl.com/asxq9h5
The Amsco V-Pro Max Low Temperature Sterilization System offers 3 high-capacity cycles for a growing list of OEM devices: a 28-minute Non-Lumen Cycle for cameras, light cords, batteries and robotic devices; a 35-minute Flexible Cycle for single- and dual-channel flexible scopes; and a 55-minute Lumen Cycle for up to 20 stainless steel lumens per load. Low moisture sensitivity minimizes aborted cycles, saves time and money, and enables reliable turnaround, says the company.