Tag Archive for: Operating Room

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Insight Series: Instrument Turnovers & Multi-Tray Sterilization Technology

(The SteriCUBE Insight Series seeks to provide frontline perspectives on multi-tray sterilization technology that is changing the way medical devices are processed and how patient safety is promoted in hospitals and surgery centers around the country. The views expressed are the sole opinion of the author and in no way reflect the position of any employer, facility, or vendor.)

Author: Mathew Scheftner, CHL, CRCST, CER – System Manager of Sterile Processing for St. Joseph’s|Candler

Many new technologies in the Sterile Processing and Operating Room space can make us nervous, and cause us to question everything we’ve previously learned about a process or workflow. Multi-tray sterilization technology is a great example of one of those concepts that pushes back against the traditional “norms.”  There are a number of reasons that this technology is worth embracing, but this article will address its impact in overcoming the challenges of instrument turnovers in particular.

Handling Turnovers with Speed

Multi-tray sterilization brings a tremendous advantage to the overall turnover process. For example, if we have a surgeon that has five sets of Total Knee Arthroplasty (TKA) instruments, we may need to turnover an entire set-up for the fifth case because it’s a double revision set-up. With multi-tray sterilization technology, the turnover process becomes much easier. You are able to process each tray as you normally would through the cleaning and assembly process, and then place each tray directly inside the multi-tray unit – basically a giant rigid container. No pans or wrap needed.

Our current units can process up to twelve full-size sets in a single load, even though we usually process nine. Imagine being able to process nine loaners and completely skip the wrap process, no corner protectors, no lint free towels, no wrap, no tape – it’s awesome. This has a real impact, not only on the speed of  the turnover process, but also on the consumable supply budget. It makes processing loaners easily twice as quick – with far less waste.

A Streamlined Turnover Workflow

When a TKA set-up turnover comes through the washers, it’s all hands on deck in Sterile Processing. Everyone scans their own tray and helps to load the multi-tray sterilization unit. At my orthopedic hospital, for instance, we process an average of 3-5 units a day, saving us from wrapping up to 25-35+ loaners on any given night. The units are prepped with new filters and locks immediately prior to the loading process to ensure that last level of quality assurance before we move to the sterilization stage.

One person is definitely able to manage the set up and loading of the unit. However, for quality assurance at our hospital, we designed the quality check for a two person sign-off. The primary technician sets up the unit and the secondary team member quality checks their work.

After the units are used in the OR and decontaminated in our department,  we wipe them down and cover them with a large bag to protect against any potential dust accumulating on them. At that point, they are usually tucked off to the side in the corner of the department.

The Biggest Helps and Biggest Hurdles

It’s difficult to overstate how much of a  crowd-pleaser multi-tray sterilization is in our department. The Operating Room team would rather pull from a single container unit than have to open up and inspect nine separate loaners wraps or deal with nine individual containers. With less time being spent processing loaners, it allows more time for all of us to focus on other important requirements of our jobs.

The biggest hurdle to multi-tray sterilization is definitely competency – and ensuring that every vendor, SPD, and OR staff member understands the impact this technology will have on our workflows. Vendors have to understand and properly communicate which trays they are checking in for which patients, since the trays are set up as complete cases.

For Sterile Processing, competency boils down to really understanding the different filters, tray placement, locks and aseptic technique of these devices. It’s critical for SPD to set the filters correctly, as well as place the trays in the unit in a way that the OR can easily remove them from the unit in an aseptic manner. Even something as simple as closing and locking these units has its own level of importance to ensure proper sterility is maintained. If SPD doesn’t ensure their side of the process is flawless, it sets our partners in the OR up for failure.

Finally, it’s the responsibility of the Operating Room to assure that all filters and locks remained in place during processing and transport of the device, and that there are no quality compromises, such as holes or wrinkles in the filters, at the point of use. Once the trays have been removed and the unit is cleared for use, it is then removed from the room and delivered back to SPD for cleaning and storage until the next use.

Understanding the impact that multi-tray sterilization technology has had on our instrument turnover workflow has changed the way we think about speed, efficiency, and staff competencies. Perhaps it will change your mind as well.

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Protecting our People: Thinking Together about Heavy Trays, Sore Muscles, and Injured Backs

 

 

The most valuable asset in your Operating Room is actually not the C-Arm or robotic console sitting over in the corner. It’s not even time. It’s your people. Without them, no patient gets wheeled back, no incision gets made, no tumor removed, and no baby gets a second chance at life.

If our people are our most valuable hospital asset, how should we think about every day workflows that could injure and harm them?

One of the most common complaints you will hear from Operating Room and Sterile Processing staff is the concern around heavy loaner and consignment instrument trays. These trays could weigh up to 25lbs* a piece and must be lifted, inspected, maneuvered, loaded, and unloaded up to a staggering hundred times a day by a single staff member in a busy hospital. There’s no wonder so many members of the perioperative team cringe when seeing large numbers of these trays set up for their particular case.

 

How to Protect your Most Valuable Assets

 

While this is a real challenge in many hospitals and ambulatory surgery centers around the United States, there are a number of things you can consider doing today to protect your people from harm:

 

1) Anti-Fatigue Mats Matter – While not flashy, anti-fatigue mats really can have a tremendous impact on technicians in SPD and the OR who have to stand long periods of time while lifting and maneuvering these heavy trays. Pay special attention to the expected lifespan of the product if one is given from the manufacturer, and inspect for damage and continued suitability on a regular basis.

 

2) Go Beyond Basic Ergonomic Training – Most facilities have some kind of limited training in ergonomics on an annual basis for all employees, but this does not necessarily translate easily in workflows that naturally involve tight spaces and the kind of twisting and turning that happens in loading and unloading loaner instrumentation. Building on basic ergonomic training that takes into account lifting of 25lbs, turning, and setting up a back table, for instance, can be helpful in standardizing safe movement and assist your team in identifying potential barriers to easy flow through the loading/unloading process.

 

3) Utilize Technologies that Hardwire Safer Practices – When it comes to loaner instrumentation and traditional packaging/container options, many of the products on the market do not account for ergonomic handling of the devices themselves. Rigid containers add additional weight to already heavy loaner trays and can make it difficult to easily remove internal contents in a sterile fashion. Disposable blue wrap requires the Sterile Processing team to individually wrap and load/unload each tray numerous times along a normal reprocessing workflow. In the OR, the blue wrap must be removed and heavy trays held outside the sterile field until any penetrations or packaging compromise is identified. This has to be repeated again and again for every wrapped tray needed for the case.

New multi-tray sterilization technologies such as the SteriCUBE™, were intentionally designed with OR and SPD end-users in mind, particularly in regards to keeping these team members safe from unnecessary workplace injury or harm due to the repetitive handling of heavy surgical instruments. The system is ergonomically designed to position instrument trays at the perfect height to decrease bending, lifting and reaching and to remain within the sterile field at all times while unloading. These kinds of innovations can have an impact on everything from worker’s compensation claims to employee satisfaction, not to mention cost and time savings.

 

 

If you haven’t considered the importance of ergonomic factors in your loaner and consignment instrument workflow before, this is a great opportunity to start a conversation with your OR and SPD staff to ask them where they hurt, and what your department can do to keep it from happening again. Any investment you make in the safety of your people will only increase the longevity and engagement of your most valuable asset – your people. It’s time you #SaveYourBack.

* AAMI ST79:2017 (8.2.(j)) states that “Instrument sets, including the sterile barrier system, should weigh no more than 11 kg (25 lbs)”