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Train and Prevent: A Two-Pronged Approach to Successful Instrument Delivery

To walk into any sterile processing department (SPD) or operating room is to be astounded by the sheer number of instruments and tools that are on hand to help surgeons help their patients. From million-dollar robotic surgical aides and special instrumentation to run-of-the-mill forceps and clamps, each tool, instrument, and piece of equipment must be cared for to ensure appropriate time in circulation and safety for patients.

And caring for it all is serious business.

A major medical center’s operating room may have over 500 instrument trays to process for surgery, and each tray contains an average of 50–80 instruments. Each instrument must be inspected for functionality, sharpness, damage, missing components, and corrosion prior to use in a surgical procedure. Without a system in place for inspection, faulty equipment can slip through the cracks and cause financial liability for the hospital, or even worse, fatal outcomes for patients.

How can a sterile processing department ensure its inventory is in good working condition? With detailed training and attentive maintenance to prevent problems from cropping up in the first place.

Training and educating SPD staff is the single most important thing an SPD leader can do to set his or her department on the right track. Flash cards, apps, mats, and books are straightforward and accessible ways to move staff toward compliance, and many instrument manufacturers provide on-site training at no cost to a facility. But of course, helping your technicians understand the reasons behind their sterilization process—the what, where, why, and when—allows them to get on board with the process in the first place. This understanding also encourages accountability and can diminish the chance of errors and defects making it to the OR.

  • What is the name of the instrument? Staff should learn how to recognize an instrument by its name and function. Techs need to know the components of the instrument by rote, so if components are left behind at a workstation, they can immediately put them back where they belong or alert their manager. Knowing the name of instruments leads to knowing its inspection points and how to test its functionality.
  • Where is the instrument used? Have your techs ever wondered in which part of the body an instrument is used? And how it is used? Invite your techs to observe a surgical procedure so they can understand where and how the instrument they have sterilized is being used. These observations generally lead to techs understanding their part in the surgical and healing process and why it is so important to get it right.
  • Why do we have to inspect the instrumentation? Teach your techs why inspection is important and run demonstrations on what happens when instrument trays are defective. Cut non-latex material with a dull pair of scissors to demonstrate the damage it could cause to human tissue. Show how a dull osteotome can bruise or damage bone tissue. Share stories about how missing screws or rivets from instruments were left inside the surgical site and caused the patient harm.
  • When is the appropriate time to perform an instrument inspection? At every turn. Instruments that break during the surgical procedure should be reported and removed from the sterile field immediately, and instruments should be inspected in the decontamination area. Knowledgeable techs in the decontamination area must instantly notice if the instrument is broken or missing a part. Sterile processing techs must inspect instruments during the assembly process, and, as a final check, the scrub technician must inspect instruments as they are readying them for the procedure.

Preventive maintenance (PM)
Though less exciting than building new tools from scratch, preventive maintenance is key to keeping things running smoothly. All instruments in a facility should be on a preventive maintenance schedule to get ahead of any potential issues, and hospitals can contract with an instrument repair company or the original equipment manufacturer (OEM) to perform routine maintenance on instruments and equipment. Irrespective of which company is doing the preventive maintenance, it is essential that the manufacturer’s IFU schedule is followed. Though not an exhaustive list, the PM program can and should touch on the following:

  • Power equipment, shavers, and electrical devices: This equipment usually has a periodic maintenance schedule of 12 months. The preventive maintenance ensures all internal components are functioning, and that the torque, heat output, and RPMs are set according to the OEM specifications.
  • Calibration: Some instruments that are used to measure or cut during the surgical procedure must be calibrated accordingly, and this calibration should be checked regularly (e.g., circumcision clamps and eye calipers).
  • Soft tissue instruments: Scissors, clamps, rongeurs, osteotomes, retractors, and needle holders are found in all the basic surgical tool sets, and each workstation should have the required testing equipment to ensure they are functioning correctly. An instrument tracking system can help collect usage data to ensure the sets go through a preventive maintenance process on a regular basis.
  • Laparoscopic instruments: Regularly check for cuts on the insulation of laparoscopic instrumentation to prevent stray electricity from entering the abdominal cavity and causing injury to the patient.
  • Flexible and rigid scopes: A preventive maintenance program can avoid costly repairs because of fluid invasion. Some repair companies have a repair exchange program, so hospitals can have all the tools they need while some are out for repair.
  • Rigid containers: Many healthcare facilities use rigid containers to package their surgical instruments, but they do not have a preventive maintenance program to ensure the gasket, latches, retention plates, and lids are doing what they are supposed to do. Start a program to ensure that your containers are maintaining the sterilization levels required.

The sterile processing department has a crucial role in patient outcomes, but without comprehensive training and a preventive maintenance program, a defect-free process is exceedingly difficult to achieve. Prioritize both and you will have your sterile processing department running like a well-oiled machine.

Mary Olivera, MHA, CRCST, CHL, FCS has over 30 years of experience in numerous roles in healthcare sterile processing, distribution, and materials management. Ms. Olivera participates in monitoring, surveying, and training interdepartmental staff in the proper cleaning, decontamination, and sterilization practices, and has been highly committed to the standardization of interdepartmental processes. A regular recruit on expert panels regarding sterile processing and a past president of the New York State Central Service organization, she continues to play a major role in promoting higher educational requirements for central service professionals to increase patient safety.

Ms. Olivera brings to the table extensive knowledge of Joint Commission, DNV-GL, AAMI, OSHA, CDC, and DoH regulations. She specializes in budgeting, change management, inventory management, process re-engineering, program and project management, vendor relationships, quality control, Six Sigma, supply chain, and total quality management.

Ms. Olivera is an educator and has published numerous articles related to sterile processing, surgical services, process improvement, and guides to achieve successful accreditation surveys.

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