INFECTION PREVENTION
Sanford Health’s Instrument Quality Conundrum
Lead coordinator, Central Processing/Surgical Services at Sanford Health shares with Healthcare Purchasing News how she became a water quality expert
By Janette Wider 1200085423 © deepblue4you |
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n 2021, Sioux Falls, S.D.-based Sanford Health’s sterile processing department (SPD) received a conditional level fi nd- ing from the Joint Commission due to poor instrument quality. The fi nding came with an increase in executive leader engagement and pressure to fi x the problem. The Sterile Processing leadership team worked 6-7 days a week for several months to go through all of the instrumentation, repair, replace and educate to new practices. The Joint Commission conducted the revisit, and the team was successful in showcasing the work they had done and plans to continue the work in the future. With the addition of about $2.5 million of new instrumentation in the depart- ment, 2022 was off to a great start. Or so it seemed, that is until some instruments started to show signs of rusting and stain- ing. Following the education provided the year prior, team members brought forward the instruments and a thorough investiga- tion started. This investigation started with looking at techniques for washing instru- ments, assembling, and sterilizer practices. Sanford SPD equipment vendor Getinge was assembled and found no deviation from IFU guidelines or equipment functionality. Still, rusting was happening before sets were ever used on patients.
Healthcare Purchasing News (HPN) spoke with Lori Buskol, lead coordinator, Central Processing/Surgical Services at Sanford Health about this very situation to gain her perspective.
One of the main chal- lenges after the visit from the Joint Commission, Buskol says, was that Sanford Health has tens of thousands of instruments and thousands of instru- ment sets. She comments, “We had to start making spreadsheets immediately on everything that we owned and that wasn’t even everything that we owned that is used in the operating room, it was everything that we used at our clinics too.” “We had one person on our team who was
Lori Buskol
really good at getting these spreadsheets put together and a few team members that were really good at fi nding instruments, which can be very challenging when you have a facility of our size,” Buskol adds. “We had 30 days to do this process before the Joint Commission was rescheduled to do their revisit. That is not a lot of time to ensure we got through everything. The staff was very engaged in this process, there was a ton of information given out to them. We do three reports per day for each shift, and we would talk about what the instruments needed to look like.” Buskol notes that there was a lot of educa- tion for the team, even so much so as having their mobile repair vendors come in and help by educating staff as to what to look for and what needed to be done. Even the purchasing team was educated on what instruments to order.
18 December 2023 • HEALTHCARE PURCHASING NEWS •
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“This was extremely challenging because
this was also during COVID, so everything was on back order,” she says. “We had to come up with a process for instruments that were still good to use but needed to be replaced fairly soon—how we kept track of those to make sure we could gather them later when the replacements came in.” Buskol goes on to explain that when new instrumentation came into the facility, they were put through a unique device identifi er process that was very time consuming. As she was working on this process, the team realized that the new instruments were just not holding up as well as they should. There were issues with rusting before instruments were even used.
This lead Buskol’s team to a water investi- gation. She tells HPN that she ran numerous tests and increased their reverse osmosis (RO) water to have a longer run cycle in their washers, which helped a bit. But she still couldn’t pinpoint where the problem was. “The more I looked into this, I noticed people on sterile processing websites talking about their instruments rusting and water quality being an issue,” she comments. “So, I started doing a lot of research on water quality.”
Through experimenting, rusting was iso- lated and found to be happening from the wash cycle. Sanford’s instrument repair partner Agiliti started putting an additional passivation layer on the instruments to try and protect them, but rusting was still showing up. It wasn’t happening to every
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