CART WASH Reprocessing techs at UPMC Presbyterian Hospital benefit from running instruments through automated washers.

Your clinical team works hard enough caring for patients, so they deserve a break when it comes to turning over rooms, scrubbing surfaces clean and reprocessing the countless instrument trays your surgeons need to keep cases flowing through the ORs. Why should they do the dirty work if they don't have to?

1. Instrument washing
Mark Lunz, director of the surgical processing department at University of Pittsburgh Medical Center's Presbyterian Hospital, has always had the benefit of working with automated washers, but the tall task of turning around instruments and devices is more challenging than ever, even with the cleaning assistance. "The big challenge is everything is so specialized," says the 20-year veteran of instrument reprocessing. "Every service has unique instrumentation for every procedure."

The tools of surgery are first and foremost designed for function, with how easy they are to clean seemingly an afterthought. "We're usually the last group to be considered," says Mr. Lunz, matter-of-factly. "It's a fast-paced environment. Just to keep the instrument flow moving throughout the assembly line is challenge enough."

Enter the department's automated washers. They help his 42 reprocessing techs decontaminate instrument sets from upwards of 120 cases a day. Last March, as an indication of the department's volume, they assembled 9,300 trays and touched 327,000 instruments from UPMC Presbyterian and UPMC Montefiore, hospitals separated by a city block and connected by a walking bridge.

Automated cart washers work like car washes, with different chambers engaging the instruments in the various stages of cleaning: pre-wash with enzymatic cleaner, general wash, pure water rinse and final dry cycle. "All the chambers can be running at the same time, so there's nice throughput," explains Mr. Lunz.

Upright washers engage instruments with the same functions, but without the added benefit of moving them through quickly in line.

Some in-line cleaners have an ultrasonic chamber that submerges robotic, laparoscopic or items with moving joints into a tank of water through which sound waves are pumped to create tiny air bubbles that dislodge matter from the nooks and crannies that manual brushing or water impingement couldn't reach. The washers can be set to different cycles — including general, sonic or delicate — to accommodate various instrument sets.

Mr. Lunz's hospital is currently in the market to add a new washer, so he's been shopping the options. Most units offer similar features, although one of the models recently peddled by a sales rep comes with software that monitors each of the system's chambers to ensure proper amounts of soap are used, washer arms don't clog, the right water pressure is delivered and the adequate temperature is reached. The software upgrade would cost $9,000. Those are nice features, but are they worth the added cost? Mr. Lunz isn't so sure.

Typically, he says, reprocessing techs run daily test cycles to ensure the chambers reach certain parameters and the units are working properly. Plus, he points out, the washers have a certain amount of built-in logic, and will abort cycles if certain criteria aren't met.

Amy Bush, RN, BSN, MBA, CNOR, who's transitioning into her new role as vice president of operations at UPMC McKeesport Hospital after spending the past 3.5 years as executive director of surgical services at UPMC Presby, believes automated washers clean instruments thoroughly, reducing the risk of exposing patients to improperly cleaned, and therefore inadequately sterilized, instruments.

Automation lessens the workload and stress on staff, letting them focus more of their attention on compiling instrument sets and loading case carts, the tasks that help improve overall surgical throughput. "When you're trying to improve efficiencies and workflow, you need the backbone of sterile processing to support the efforts," says Ms. Bush.

2. Surface cleaning
Proper manual cleaning effectively eradicates microorganisms, but relying on busy surgical personnel to use the correct agent for the recommended exposure time subjects surface disinfection to the whims of human error.

Systems that disinfect rooms at a time support your staff's efforts. And when it comes to automated whole room disinfection, your options are many: ultraviolet light, aerosolized hydrogen peroxide, hydrogen peroxide vapor, cluster ions and ozone gas. Whole room disinfection takes time, typically making it appropriate as an adjunct to terminal cleaning at the end of the surgical schedule, not as a go-to solution for between-case turnovers.

Ms. Bush trialed whole room disinfection systems 3 months before leaving UPMC Presby. Staff there rotated the systems throughout the hospital's 44 ORs, attacking a series of different rooms each day. "With hospital-acquired infections becoming a major issue, and facilities doing all they can to prevent them, the systems will play a key role," she says.

TRACKING TECHNOLOGY
Do You Know Where Your Instruments Are?

EYES EVERYWHERE Tracking technology lets you keep tabs on instrument maintenance and reprocessing performance.

Automated instrument tracking improves clinical efficiencies and patient safety, says Amy Bush, RN, BSN, MBA, CNOR, vice president of operations at the University of Pittsburgh Medical Center's McKeesport Hospital.

Linking instrument tracking to the electronic documentation of sterilization cycles and instrument manufacturers' instructions for use takes some of the human element out of reprocessing and lets you monitor instrument usage, including how many times they've been cleaned and sterilized.

What happens if you need a specific instrument tray for a case? A tracking system can tell you exactly where it's located, whether it's been pulled for another procedure or if it's sitting in a different OR.

The technology also lets you keep tabs on the productivity of your reprocessing department. How many individual instruments, peel packs and trays do they handle? How many steam, low-temperature and ultrasonic cycles do they run? What are the average cycle times? How long does it take after the time instruments are received until they're ready for the OR? How many trays do specific techs put together in a shift? How accurate are they in doing so? With instrument tracking, you'd know and would be able to use the data to initiate quality improvement projects aimed at upping staff performance.

— Daniel Cook

3. Fluid waste management
Direct-to-drain fluid waste management involves collecting runoff in a system's closed rover unit, which is then transported to a docking station, where the fluid is automatically offloaded into the waste drain. Automating fluid management in your ORs keeps the rooms cleaner, letting the surgical team focus more on patient care, and helps them track how much irrigation fluid is going into the joint and how much is flowing out.

Ms. Bush's surgical team uses direct-to-drain systems during orthopedic and GYN procedures. It's a far cry from her days as a new OR nurse, when towels were used to sop up excess runoff. "Irrigation fluid would leak all over the drapes and spill onto the floor," she says. "It was a slipping hazard, you didn't want it to run into electrical cords and you certainly didn't want to come into contact with it."

Her staff never touches fluid waste, and doesn't have to lug filled disposable containers to the hopper, a physically demanding task that increases the possibility of back injuries and being splashed with contaminants. There's no doubt direct-to-drain systems are easier and safer for staff to use, which also translates into faster room turnovers.

Says Ms. Bush, "The facilities that use the systems see clear benefits, from improved safety to staff satisfaction."