CS CONNECTION
address the capacity needs and meet the demands and future needs of the health system (see sidebar).
Single-use device reprocessing Lars Thording, Vice Presi- dent of Marketing and Pub-
Kimberly Jones
lic Affairs, Innovative Health, indicates that the COVID-19 pandemic has also dramati- cally changed the way hospitals and hospital staff view single-use device reprocessing. “Since summer 2020, we have seen an uptick in hospitals that want to use reprocessed single-use devices – and a significant increase in volume from our existing hospital part- ners,” Thording stated.
Lars Thording
“I attribute this to two things. First, since the personal protective equipment (PPE) shortage, hospital staff have developed a new mindset about reuse. They are thinking twice before throwing away a used device. Second, the financial hit to hospitals from the pandemic has increased the level of importance associated with cost savings. Single-use device reprocessing reduces costs without adding risk and ultimately equips financially strained hospitals to provide better patient care.”
Don’t make it all or nothing Rather than keeping CS/SPD operations on- site at each hospital, or moving everything off-site to a separate facility, many health- care organizations continue to consolidate reprocessing to a single hospital within their network.
“Within the Chicago market, we have not seen any dramatic change in repro- cessing strategies. However, we have all seen several large integrated delivery networks (IDNs) move to a centralized reprocessing approach (e.g., UPenn, Uni- versity of Iowa),” said Jodi L. Eisenberg, Chief Quality Officer, Vested Medical. “What is important to con- sider is the misconception that it’s an all or nothing decision. What might be more appropriate is to think about the optimal approach for each type of surgery and to have an option to select either an on-site or an off-site alternative, depending on the criteria. Additionally, while it might be possible for a large IDN to invest $80 million in an off-site reprocessing center, how realistic is it for the community-based healthcare facilities and the stand-alone ASC that need options?”
Jodi L. Eisenberg
Eisenberg says she has seen some health systems keep most reprocessing on-site, while leveraging an off-site facility as a “pressure-relief strategy for the most chal- lenging surgeries.”
“Two examples are total hip arthroplasty (THA) and total knee arthroplasty (TKA) that rely heavily on loaner trays and are very challenging for most sterile processing teams,” she said. “Off-loading these surger- ies provides immediate relief for SPD staff but also provides a contingency when it makes sense to sterilize on-site.” Dr. Garrett has seen movement towards centralization for a variety of reasons, most notably standardization of reprocessing, reduced costs and the ability to preserve valuable real estate.
“There are some disadvantages as well from potential delays in device avail- ability,” he said. “The FDA has also rec- ommended eliminating the reprocessing process for high-risk procedures, such as endoscopic retrograde cholangiopancrea- tography (ERCP) due to the potential risk for healthcare-associated infections. This can most easily be accomplished by utilizing disposable duodenoscopes.”
Impact on ambulatory surgery It is not just hospitals that have suffered revenue loss from a downturn in elective surgery volumes, ambulatory surgery cen- ters (ASCs) have been equally if not more challenged, notes Vested’s Eisenberg. The impact of COVID-19 pandemic is being felt in all areas of healthcare,” said Eisenberg. “Over the past year, we have seen a halt to elective surgeries, which meant a decrease in volumes for both acute settings as well as ambulatory settings. As
we stabilize the pandemics effects, health- care organizations are looking to ways to ramp up the revenue streams. Add to this the recent payor changes to the rules for reimbursement on the ambulatory side, the opportunities are ripe to increase ambula- tory surgery volume.”
But a sharp increase in ASC procedure volumes poses challenges to on-site repro- cessing, according to Eisenberg, prompt- ing some to consider a switch to off-site/ outsourced CS/SPD operations. “Unfortunately, many of these ASCs
do not have the capacity nor a sufficient team of properly trained sterile process- ing staff,” she said. “Some of the surgeries that are being pushed to the ambulatory setting include orthopedics. These elective surgeries require the use of complex surgi- cal instrumentation and implants, which are delivered in the form of loaner trays, in most cases, less than 24 hours prior to the surgery. Space, capacity and staffing in the current ASC model don’t appropriately support this care. This is where off-site reprocessing gains more support because, like many other hospital services, there are benefits to outsourcing this activity to a more production-oriented, quality-focused partner.”
Reasons for reprocessing shifts Whether a healthcare organization is revamping its on-site CS/SPD operations, centralizing them to a single hospital or moving everything to an off-site facility, the decision takes careful consideration, and the process can be both complex and challenging. Here is advice from those who have experience doing it.
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Communication, collaboration key to OSU Wexner off- site reprocessing success
In 2017, Ohio State University Wexner Medical Center (OSU) examined the growth plan across its enterprise for surgical volume and determined that given the current footprint of Central Sterile Supply (CSS) across the enterprise, building a freestanding CSS hub was the most strategic financial solution for the organization. In planning the facility, CSS team members played an integral role in the facility design, which features abundant natural light and evolutionary state-of-the-art equipment. From a growth perspective, the building was designed to accommodate the current state surgical volume, as well as the future state of surgical services through the year 2027. OSU opened its new off-site CSS in February 2021. “Operational preparation and collaboration with our operating room (OR) partners could not be understated,” said Kimberly Jones, BA, CRCST, Director of Central Sterile Supply, Main Campus, OSU. “We worked tirelessly with our clinical partners to examine current processes involving OR and CSS. Ultimately, we collectively reevaluated current practices and made modifications preemptively to accommodate the off-site facility. Additionally, we involved our surgeons early on to obtain the necessary buy-in and support to go live with new workflows.” “Some of the lessons learned within the first 30 days after opening the facility relate to
communication, follow through and continued partnership with our subject matter experts,” Jones added. “Having had a successful relationship with theses partners prior to go live has enabled open communication when processes need to be modified.”
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