OPERATING ROOM Keeping instruments patient-ready
IFUs, training, inspection and tracking hold keys to safety by Ebony Smith
P
erhaps, the most precious resources in the operating room (OR) are the instruments used on patients. Whether used for surgeries, treatment or other care, these devices, in essence, can be lifesaving or life-endangering for patients. “Surgical instruments are one of any healthcare system’s most valuable assets,” empha- sized Juan Ramos, BSBA, CRCST, CIS, CHL, LGBC, CSD Lead Consultant, Aesculap. “We should do everything we can to pre- serve their value. Instru-
Juan Ramos
ments are central to safe and effective patient care.”
Unusable devices are costly What is the impact of malfunctioning, unster- ilized or unsafe instruments in the OR and patient care? “‘Poor reporting of patient safety incidents means that there may be as many as 1,500 incidents a year of poor-quality surgical instruments causing harm.’ (Elizabeth D. Dominguez),” Ramos explained. “There is a direct correlation between instrument care and safe patient care. Poor instrument quality can lead to unsatisfi ed physicians and other team members, surgical delays and operational costs associated with overtime because cases run late. nsatisfi ed coworkers and staff can lead to a high turnover rate.” Another calculation is the total cost of
ownership, describes Crit Fisher CST, FAST, Director, Onsite Service & Operations, KARL STORZ Endoscopy-America, Inc. “This is the cycle from acquisition to repair or replacement,” Fisher stated. “Following the IFUs and using good techniques in cleaning, sterilization, storage, access, tracking, transport and use of the instrument will affect its longevity.”
Crit Fisher
He added, “Related to safety and care, nothing is more frustrating than having a surgical instrument that does not work. Dull scissors and trocars and graspers that will not hold add to surgeon irritations and lead to potential tissue damage and the need to open multiple sets of instruments. This, in combination, adds time to the surgical
procedure. Also, having a rigid endoscope with a dirty distal tip or damaged rod lens affects the surgeon’s ability to see.” Supply inventory, surgeon performance, and Sterile Processing and Distribution (SPD) ser- vice additionally may be affected, expresses Michael Matthews, Director, Clini- cal Education & Training, Northfi eld edical. “Any device that is func- tioning sub-optimally is
Michael Matthews
going to require adjustments by the sur- geon,” Matthews indicated. “Additionally, device failure creates stress on both operat- ing room staff and reprocessing staff by reducing the number of functional devices in their stock. Increases in stress have been demonstrated to lead to additional mistakes; these mistakes can affect patient outcomes and do additional damage to the remaining stock of devices. The only way for hospitals to break out of the loop is to become proac- tive in device maintenance and process improvement.”
COVID-19 burdens staff, supplies, care
As the COVID-19 public health crisis con- tinues to rule communities and healthcare, SPD departments provide an essential role tracking, inspecting, cleaning and sterilizing instruments for safe use on patients. SPD teams, however, require the right tools and systems to perform their jobs effectively and shield themselves from infections. Personal protective equipment (PPE), reprocessing chemicals and equipment, and medical device training must be accessible. “As case numbers continue to increase, it
will be vital that the optimization (effi ciency) of tray contents, communication among departments, and turnover (both OR and SPD) are at the forefront of decision making,” urges Michelle Lemmons, RN, BSN, PHN, CNOR, Key Surgical. At the start, much uncertainty revolved around SARS-CoV-2, the virus that causes COVID-19, notes Ramos. “One main challenge for OR and SPD pro- fessionals at the beginning of the COVID-19 pandemic was fear of the unknown,” Ramos indicated. “Is this virus different from any other virus or infectious agent that we work
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with on a day-to-day basis? Are our systems of precaution suffi cient to protect ourselves and others from further contamination?” He continued, “Another challenge was the
scarce supply of PPE around the country. We are all familiar with the isolation precautions: ‘Wear PPE (e.g., gloves, gown), according to the level of anticipated contamination, when handling patient-care equipment and instruments/devices that are visibly soiled or may have been in contact with blood or body fl uids.’”1
COVID-19 created barriers and opportuni- ties for medical device education that SPD departments rely on, points out Matthews. “Education is the backbone of all activi- ties in sterile processing, and many facili- ties depend on their vendors to provide regular education to their staff,” Matthews explained. “When the COVID-19 response restricted access of vendors to facilities, an unintentional consequence was decreased accessibility to in-person training and educa- tion. This has led to an explosion of interest in non-traditional educational sources.” Rising volumes of procedures in the OR are another concern for SPD and OR depart- ments in the midst of the ongoing crisis, expresses Lemmons. “While the intraoperative
and post-operative cleaning and decontamination of instruments remains the same in the wake of the COVID-19 pandemic, there is a significant emerging challenge for OR and SPD
Michelle Lemmons
professionals, the upcoming surge in surgi- cal cases,” Lemmons noted. “Many facilities will be looking to regain lost revenue by increasing their surgical case numbers. This increase, while understandable, will cer- tainly place a strain on both departments and device and instrument cleaning, sterilization, storage, access, tracking, transport, use and repair. If not approached with a great level of respect and consideration, these increases carry a substantial risk of causing negative patient outcomes.” She continued, “Unique considerations include: • Operating rooms that have set up ante- rooms for COVID-positive patients (pre- or post-procedure) can cause access, tracking,
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