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The Sterile Processing Foot Locker: Lessons Learned from the War on COVID-19

One of early lessons we can learn from the COVID-19 pandemic is that we are very reliant on the supply chain and that chain is vulnerable to any kind of disruption. Even without a manufacturer back order, the chain is only as strong as its weakest link. A specific product can not make it to your facility for a whole host of reasons, putting you short of the critical supplies you need. Supplies you never considered for one purpose may suddenly become essential for another.

This sensitive supply chain can also be impacted by a host of other reasons: hurricanes, blizzards, tornadoes,earthquakes, or any weather phenomenon. There are also man-made disasters to consider, such as recalls, labor strikes, and traffic accidents. Often there are seasonal disruptions around major holidays and delivery systems can get clogged and overwhelmed, causing delays. Then there’s the most classic human error of all where maybe you just forgot to order the items. These are a few of many scenarios that are both known and unknown.

What you can do to prepare? Identify existing supplies in both the department and storeroom. Take a moment to identify any critical supplies you need to keep the SPD factory running in the event your deliveries do not make it to your facility. This can be done as a risk assessment with all pertinent members of the team.

Break down the needs list by areas of function in the department. Begin with pretreatment at the point of use and work your way through each of the department areas, such as decontamination, assembly, sterilization, and sterile storage.

The materials management professionals in the hospital purchasing department can help you determine your safety stock through proven concepts, such as economic order quantities (EOQs) or other techniques that can essentially leave you with a certain amount of supplies on your shelf from the time you order until the time your restock arrives. The EOQ model is used in inventory management by calculating the number of units a company should add to its inventory with each batch order to reduce the total costs of its inventory.1 If that was too much for you, that’s why I mentioned that we use our materials professionals for help. Part of supply management reorder points look at the lead time or amount of time it takes to order a product and actually receive it at your facility.

Some products, such as chemicals or detergents, have to ship via ground delivery only and take longer; if you’re on the East cCoast and order from the West Coast, there is a longer ship time.

These lead times all assume smooth delivery and consideration may be needed for the extended nature of these parameters by adjusting reorder points upward, which in turn leaves more stock on hand between deliveries. Your materials management professionals may or may not use these formulas, but the general takeaway is that we need to reconsider the on-hand quantities of the critical supplies that keep your SPD functional.

This is a great opportunity for you to collaborate with these professionals in the hospital. It is safe to say that we have all learned a lesson and that the paradigm must shift. Prior to the outbreak of this virus and the collapse of the supply chain, most philosophies on inventory management relied on a system of just-in-time delivery (JIT), which is reliant on a fully functioning supply system that has little to no disruptions. We are truly looking at critical-function supplies because there needs to be a balance between overstock and the amount of the associated cost or dollars on the shelf at any given time. Another reason we work with this team is because there are often parts of our supplies that are in the main hospital storeroom and they may have limited space. Some supplies are also warehoused in either a hospital or a distributor’s warehouse that’s nearby, and this reduces the lead times. They would know all this.

Another option to increase the on-hand supply if the offsite warehouse, storeroom, or the existing shelf space is insufficient is to consider a small on-site storage area for on-hand storage of these critical supplies.

Some examples of these critical supplies include:

  • Detergents for manual and mechanical washers
  • Point-of-use sprays or kits
  • Cart covers
  • Indicators of all types (internal, external)
  • Sterilization tape
  • Blue wraps
  • Peel pouches
  • Dust covers
  • Chemical and biological PCDs
  • Tapes and supplies for barcode tracking system
  • Okay, I put this in to make sure you are paying attention.

You would not want these or any other supplies to expire. To achieve this we must practice a first in, first out (FIFO) supply pulling method. If these supplies are in a separate area, you pull what you need for the user areas from these supplies and replace that with the new, fresh supplies that come in from your last delivery. This is best practice for even existing inventory, so be sure you practice this important method.

You want these supplies to be managed and have an active inventory list with the following information:

  • Product name
  • Quantity on shelf and units (4 boxes of 50 each)
  • Expiration date
  • Lot number (in case of recall)
  • Location
  • Any other pertinent information that your system requires.

While we still battle the COVID-19 virus, one of the early takeaways is specific to decontam and the lack of PPE. In this case we want to have some extra supply of existing disposable PPE, but there is also opportunity to look at as many reusable products that are available in the event that there is an extended shortage.

The lack of proper PPE can shut down the department and jeopardize both the patients and the healthcare workers in SPD. These are unprecedented times we are in with regard to PPE and supplies. To be prepared for this we should identify the critical items needed for functionality.

Sterile processing departments can create a decontam foot locker that is stored somewhere on campus that contains the following PPE for decontam:

  • Reusable aprons
  • Reusable arm sleeves
  • Reusable face shields
  • Reusable nitrile (department specific)
  • Assortment of cleaning brushes
  • Washer testing supplies
  • Assortment of brushes

Notice we looked at reusable alternatives as this allows more with less space.

Even if there were no options available to you inventory-wise, as mentioned earlier this can be achieved. These items can be placed into your foot locker at a quantity of your choice depending on your particular staffing levels and volumes. The actual foot locker is your choice, though preferably it is not a corrugated box. Perhaps use a storage bin and dust cover the individual items for better protection. Again, these are suggestions as many of us do not have the ability to acquire any additional space for storage or can’t fit any additional supplies onto our existing shelves. Consideration can even be given to storage in one of the offices or locker areas, if necessary.

There were many other lessons learned in that masks were made from sterilization wrap and many other products were made from other materials. Reprocessing N95 masks suddenly appeared. Were departments stocked with enough biological indicators and peel pouches to facilitate this? We may want to consider this in our preparedness planning in the event that this needs to be done again. These are valuable lessons and we continue to learn from this war on the virus. We need to always think outside the box in SPD.

These are small steps and considerations that we can take to ensure continuity of the department for contingencies that are possible and unforeseen. Remember they saying, “By failing to prepare, you are preparing to fail.”

Reference:

1. https://www.investopedia.com/ask/answers/052715/how-economic-order-quantity-model-used-inventory-management.asp


 

David Jagrosse, CRCST, CHL, has 30 years of experience in CSSD/SPD as a technician, supervisor, and manager. He was the Connecticut Central Service Association communications officer (1998–2000), vice president (2006–2008), and served three terms as president (2009–2015). David was a member and chairman of the ASHCSP Recognition Committee. He works with the AAMI Standards Work Group 40 (ST79) as an active voting member that develops guidelines in CSSD, and is the director of the oneSOURCE Speakers Bureau. David is active with IAHCSMM as a member of the orthopedic council and speaker at annual meetings, and has served IAHCSMM in many capacities, including president (2015–2016). He has been published in Communiqué/Process, Infection Control Today, Healthcare Purchasing News, and AAMI Horizons. David is a consultant for AAMI-based audits to CSS/OR audiences internationally.

 

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