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SPECIAL REPORT Enhancing safety and efficiency in


orthopedic surgical instruments The case for a pre-sterilized, single-use,


computerized tracking platform Michal M. Szpara, DPM and Matthew W. Lawrence, DPM


H


ospital-based elective surgery is entering a new era of innovation, accelerated in some respects by the burden that COVID-19 placed on urgent care and the institutional infrastructures that support it. The story does not begin with the pandemic, though, and a look back reveals the deeper inefficiencies from yesterday, as well as some of the most promising solutions for today and tomorrow.


One case in point is orthopedic surgical hardware, which engages


a number of processes that no longer meet contemporary delivery sector challenges. Historically, orthopedic surgical instruments have been delivered to each individual facility in non-sterile, re-usable trays – or sets – by a medical device company’s local representative, who is also responsible for stocking each tray with screws, plates, drills, and other needed instruments. Today, the dependency on the rep remains the assumed “stan- dard of care” in the orthopedic community, despite other services and procedures (anesthesia, cardiac rhythm, and neuromodula- tion, to name a few) that have already adopted a disposable pro- cedure pack delivery platform that make the rep less of a presence and dependence.


Safety and cost benefits of sterilization Innovations like these, as well as sterile single packed instrumen- tation and implants, may not make surgical site infections (SSIs) obsolete, but they can significantly reduce s linked to contami- nated or inadequately processed and sterilized equipment, saving hundreds or potentially thousands of lives each year. The current rate of SSI in the United States is about 1.07 per- cent. These infections are directly responsible for approximately 8,000 deaths per year1


, and it is estimated that the average cost


to treat surgical site infections totals between $10,000 to $50,000 per patient2


.


Surgical instruments and foot care equipment are critical devices, according to paulding’s classification, and require the highest level of processing. In one study, OR nursing and perioperative staff were asked how long it took to clean, process, and sterilize instruments for upcoming cases. Fifty-one percent of these clinical respondents found the sterilization process to take more than 90 minutes, 32 percent claimed 61 to 90 minutes, and only 10 percent said it took less than an hour (31 to 60 minutes)3


.


The average reprocessing cycle from decontamination to sterile storage takes more than four hours4


OR time is estimated at $62. Based on these estimates, the cost of simply waiting for the surgical instruments and implants to be sterilized costs an average of nearly $4,000 per cycle5


. Instrument and device tracking


While time is a critical resource to measure within health systems, instrument and implant-tracking and supply-chain management is often overlooked, and the impact on efficiency can be considerable.


. The value of one minute of


Lost, unreplaced and obsolete instruments amount to over 10 percent of the cost of maintaining reusable instruments each year6


.


Compromises in instrument supply also result in delayed surgical turnover time.


In contrast, recent innovations in single-use, disposable instru-


ments that can be computer tracked and resupplied have the potential to save more than $400 per case simply by reducing hospital staffing and delays, while eliminating steriliation cost7


.


Solutions from Gramercy Extremity Orthopedics Among the innovation leaders in these surgical support solutions are external suppliers of sterile instruments and devices. Gramercy Extremity Orthopedics (GEO) was founded in 2015 with the goal of providing a more cost-effective, user-friendly, and efficacious way to deliver orthopedic medical implants. Unlike traditional surgical instrumentation and implants, GEO implants and its correspond- ing single-use instrumentation come individually-packaged in a state-of-the-art delivery system, the GEO CART. Through a series of new products and features, today’s GEO CART is a computerized, RFID-enabled mobile implant and instrumentation inventory apparatus capable of holding over two thousand items. These items are placed in each tailored cart – by hospital or ambulatory surgery center (ASC) – according to individual surgeon preference.


These innovations are both cost-effective and time saving, which ultimately benefit the facility, the clinical staff, the surgeon and, most importantly, the patient. HPN


References


1. Dancer SJ, et al., Surgical site infections linked to contaminated surgical instruments, Journal of Hospital Infection (2012), doi:10.1016/j.jhin.2012.04.023 (PDF) Surgical site infections linked to contaminated surgical instruments. Available from: https://www.researchgate. net/publica- tion/227167487_Surgical_site_infections_linked_to_contaminated_surgical_ instruments[accessed Aug 18 2021].


2. Anderson DJ, et al. Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29:S51-S61.


3. Welker, D.M., MD (2019, August 1). The Clinical and Economic Case for Sterile, Disposable Instrument and Implants. Infection Control Today.


4. U.S. Food and Drug Administration. Unique device identification – UDI. http://www.fda.gove/ MedicalDeives/DeviceRegulationandGujideance (http://www.fda.gove/MedicalDeives/ DeviceRegu- lationandGujideance/). Accessed March 25, 2015.


5. Association for Professionals in Infection Control and Epidemiology (APIC). Guide to the Elimina- tion of Orthopedic Surgical Site Infections. Washington, DC: APIC; 2010.


6. Brooks T. The complex and indispensable requirements for instrument reprocessing.http://www. infectioncontroltoday.com/ (/). Accessed March 31, 2015.


7. Welker, D.M., MD (2019, August 1). The Clinical and Economic Case for Sterile, Disposable Instrument and Implants. Infection Control Today.


Matthew W. Lawrence, DPM and Michal M. Szpara, DPM are partners in private practice in Connecticut and Rhode Island at Coastline Foot and Ankle Specialists. They serve as Co-Medical Directors of Podiatric Foot and Ankle Surgery at Yale New Haven Health Southeast Region in both Connecticut and Rhode Island where they are also key in surgical training of Yale podiatric surgery residents.


hpnonline.com • HEALTHCARE PURCHASING NEWS • May 2022 17


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