STERILE PROCESSING
endoscopes for minimally invasive proce- dures. Thus, having a specialized repro- cessing service with trained personnel can eliminate error,” said Frieze.
Decentralization of surgical services Tom Redding, Senior Director, St. Onge Company, notes how health systems are under continued pressure to reassess their surgical strategies to deter- mine the appropriate balance between decentral- ization and regionalization of surgical services. “As the number of loca-
tions expand, the potential for ineffi ciencies and quality
Tom Redding
control will become more challenging for the health system,” said Redding. “The need to develop a reprocessing ‘center of excellence’ for the organization can be a critical enabler for growth of surgical services.” “At St. Onge, we’ve had the opportunity to
work with fi ve health systems in the last year to assess and develop the centralization strat- egy for device and instrument reprocessing,” he added. “The shortage in staffi ng and the decentralization of surgical services is forcing the health system to not get stuck in the ‘build it again’ mode for reprocessing services. We are seeing signifi cant pressure on existing reprocessing infrastructure and the inability to expand their footprint to meets the needs of the facility and organization.”
Equipment and process duplication Crowe comments on how a centralized approach to reprocessing enables a health system to optimize resources – from staff training to instrumentation. “Most health systems initially begin to eval-
uate a consolidated reprocessing operation as simply a cost and space saving measure. And, while the evaluation of the business case will often prove positive, the true value proposi- tion for the health system is beyond any direct monetary benefi ts,” said Crowe. “A centralized facility provides the opportunity to centralize training for staff, to more easily share instruments across the health system, engage surgical services in standardization, and improve staff satisfaction and retention.” Centralized reprocessing for offsite clinics
has been the fi rst step for many health systems, says Bryan Stuart, National Director of Consulting, Aesculap, in their efforts to maximize resources. “Let’s say you had an anchor hospital with 40
Stuart. “Therefore, the first big wave of standardization that I saw nationally was health systems centralizing reprocessing for clinics within one CS/SPD site. That move began raising challenges with regards to offsite reprocessing, including inadequate device/instrument inventories to support this model.”
While Frieze personally feels each facility
needs to control their processes and devices, and ensure that the patient comes fi rst, she notes how offsite reprocessing might be a good option for ambulatory surgery centers (ASC), stating:
“ASCs could send a majority of their devices to the main facility daily to ensure that the full process of cleaning and steril- ization occur with the same level of care as the hospital. Given the expense of low tem- perature sterilization, if each facility was to acquire this type of sterilizer it would be very costly to do so. If moisture and temperature sensitive devices are not used daily or several times a day, there is little need to invest in a low temp sterilizer for example. On the other hand, an endoscopy suite would be justifi ed to make such a purchase.”
Space constraints “From the central sterile (CS) or sterile processing department (SPD) perspective, there are facilities that are large enough to perform onsite services easily. However, there are also facilities that have outgrown their onsite capabilities due to the addition of more surgical physicians or more surgical procedures,” said Hassan Bilal, CRCST, CST Consultant, Educator, Author at Medline. “This can overwhelm their CS/SPD leading to the need for a change.” “Some large hospital groups have a dif- ferent perspective,” he added. “Due to their size and footprint, many have decided that offsite works better for the group and has developed one centralized location offsite to perform all the SPD duties for all the hospitals in the group.”
Bryan Stuart
clinics, 25 of them offsite, where each clinic was performing its own reprocessing. Processes and quality could be all over the board from one clinic to the next,” said
According to Stuart, many health systems that have begun “right sizing” inventory to match volume suddenly realize they do not have the space to reprocess added items. “Health systems began realizing that although they might have adequate space to store additional sterile inventory, they lacked the equipment and space to sup- port the workfl ows required to reprocess this additional instrumentation,” he said. “For most CS/SPDs, it is very challenging to acquire additional space unless it is new construction that takes into account today’s sterile processing demands.”
Disruptions to CS/SPD operations Sometimes the decision to move reprocess- ing offsite isn’t a choice but a necessity.
28 June 2022 • HEALTHCARE PURCHASING NEWS •
hpnonline.com
“In some cases, facilities may have inter- nal problems such as steam quality, which will shut down their department and drive the need for portable SPD units which can operate outside of the external department,” said Bilal.
In the province of Ontario and around Canada, Louis Konstant, Clinical Manager, Medical Device Reprocessing Department, Sick Kids, the Hospital for Sick Children, has seen cases where a hospital’s aging CS/ SPD infrastructure contributes to accredita- tion standards not being met that may result in consideration of offsite, third-party reprocessing. “Most hospitals in the
Toronto area are stand- alone in terms of their medical device reprocess- ing and while third party reprocessors have served few larger hospitals in the recent past, they cur- rently serve mostly as a contingency,” said Konstant. “Over the past few years, I have seen some healthcare organizations with systemic issues that could not reprocess onsite, so they have turned to a third party in the short run until the problems are resolved.”
Louis Konstant
Konstant says while CS/SPD depart- ments viewed third party reprocessors with caution in the past, this is changing. He states:
“In general, we are creatures of habit. Moving reprocessing offsite into the hands of a third party is a major change for an organization so many felt it was threaten- ing. They saw risk in individuals outside of the hospital reprocessing items, perhaps not up to their internal quality standards and the devices not being available when needed. As well, the long-term viability of the offsite service and the difficulty of returning back to an onsite model are a concern. They also felt these parties threatened sterile processing jobs inside hospitals.
“Attitudes are shifting as more organiza- tions have shown successful partnerships with third party reprocessors,” Konstant added. “For many they are now seen as a back-up and serving smaller centers that don’t have the resources to set up something onsite or have had some accreditation fl ags and don’t want to assume the risk of onsite reprocessing.”
Factors that improve offsite success
While offsite reprocessing can have its advantages, including process standard- ization, there are a variety of factors that a health system must take into consideration for this model to be successful.
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