Innovation
Driving efficiency with robots in sterile services
An ageing population, tight labour markets, the ergonomic strain on employees, rising healthcare costs and sustainability goals are forcing hospitals to rethink the design of processes in the Central Sterile Services Department (CSSD). Robotic wrapping of medical instrument trays can contribute to a solution for these challenges, according to Mariska van der Vliet and Niels Welling.
Wrapping an instrument tray, equipped with medical instruments, is the final step before sterilisation and reuse during a new medical procedure. To ensure sterility of the medical instruments in the instrument trays, it is essential that a validated folding method be performed according to protocol.1
medical instruments. Using a rigid container as a barrier system has the disadvantage that there is a greater chance of ingress of airborne bacteria after sterilisation.2
American research This involves
forming a structure in which the wrapping material includes multiple slings that ensure proper closure. Blue wrap is usually used for wrapping – a
non-woven polypropylene material that allows steam to pass through during the sterilisation process, while providing a barrier against external contamination, keeping the sterilised instruments protected until aseptic presentation in the operating theatre. Reusable rigid sterilisation containers are used in some hospitals as a barrier for cleaned
based on a static bioaerosol test shows that the barrier effect of rigid containers is lower than that of blue wrap. 87% of the studied containers demonstrated bacterial ingress after the test, compared to 0% of the wrapped trays. Thereby, contamination rates of rigid containers increased significantly with increasing duration of use.
Disadvantages of manual wrapping Currently, the wrapping process of cleaned medical instruments worldwide is done by hand. Manual wrapping of instrument trays has several disadvantages – for example, wrapping
is monotonous work that requires a constant, high level of concentration. The reproducibility of that manual process is not guaranteed, which can lead to undesirable quality differences between wrapped trays. Wrapping quality is additionally threatened when guidelines for wrapping are not available in the hospital.3 If the sterile closure does not meet
requirements, the instrument tray must be reprocessed. The instruments must be re-cleaned, reassembled, wrapped and sterilised again. An American study shows that reprocessing medical instruments costs €0.47 to €0.71 per loose instrument.4 If the same, sterilised instrument tray is not available, surgery must be postponed. The cost of cancelled operations internationally is estimated to be between €1385 and €3131 per cancelled operation.5 A second disadvantage is the risk of contamination with human materials, such as hair or dander, during wrapping. Contributing risk factors include bending over the instrument tray, leaning on wrapping material with bare arms or hands, or contaminated clothing. The wrapping material can also become contaminated because storage material is not kept under proper conditions in the CSSD, such as wrapping material partially touching the ground. Contamination during the wrapping process can lead to post-operative wound infections, which in turn lead to poorer health outcomes and high costs for hospitals.6 Furthermore, manual wrapping of instrument
trays is physically demanding work, which can lead to musculoskeletal disorders. For example, in a Brazilian study, 21% of CSSD workers reported suffering from tendinitis, an inflammation of tendons around the elbows, wrists or shoulders.7 Finally, an ageing population poses a threat
April 2024 I
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