Beyond Testing and Repairing Instruments
By Teckla Ann Maresca, LPN, CSPDM and Nora Wikander, RN, CSPDM
A big challenge to today's healthcare facilities is to provide the best possible service to our customers while staying within strict financial confines. As budgets dwindle, we face an increasing need to scrutinize our departments for ways to improve our processes while maintaining and/or reducing costs. Often, the initial solution employs a form of "tunnel vision" that eliminates those tasks or processes that do not appear to have a value equal to the costs associated with them. Performing routine, preventive maintenance of surgical instrumentation is one example of such tunnel vision. When looking at the expense of having trays and sets routinely inspected, sharpened and realigned, we frequently do not consider the collateral costs of surgical procedure delays resulting from instruments not functioning properly, the increased cost to replace improperly cared-for instruments, and the ultimate impact on customer service. Further, it must be understood that surgical instrumentation and/or equipment is a major portion of a hospital's assets.
Previous articles have discussed the routine testing and inspection of surgical instrumentation. In this article, we will concentrate on the process of maintaining surgical instrumentation as opposed to the actual tasks associated with the process such as testing, cleaning, inspection and sterilization. A process that is based on preventive maintenance and knowledge of the instrumentation being processed will avoid unnecessary costs and repairs, improve functionality and, ultimately, improve customer satisfaction.
Maintenance of instrumentation begins, in some instances, before the instrument is purchased. It requires a cooperative effort between the processor and the end user with open lines of communication. When anticipating the purchase of advanced technology and/or instrumentation, consideration must be given to the complexity of cleaning the instrument(s), the actual sterilization process, limited reuse information and related costs of disposable accessories needed to care for the instrument(s) or provide for its routine use. After looking at these issues, it may be determined that additional research and an alternative may be the best approach. At this point, there are probably several things going through the reader's mind, such as:
- What does this have to do with maintenance of instrumentation?
- How am I going to know about an item before it is purchased?
- Who's going to tell the operating room or a physician that they can't have an item?
Much of the new instrumentation related to changing technology is, by nature, extremely complex. Among the issues to consider are if the item can be adequately reprocessed (cleaned and/or sterilized) by your facility. Among the questions that must be answered are:
- Are the instructions for reprocessing adequate? Do they include clear direction for disassembly, reassembly, detergents to be used (or avoided)?
- Are specific means of cleaning (e.g., ultrasonic) provided, and are they available in your facility?
- Can the item be sterilized by utilizing accepted means available in your facility?
- Is the sterilization cycle a special one requiring adjustment of the parameters of sterilization? If so, can this be done in your facility?
- What is the testing procedure?
As you can see, unless these questions can be answered positively, you cannot maintain the instrumentation in question. To your advantage, having these answers prepares you to maintain and process the instrument from the day it arrives.
You can be in the loop prior to the purchase of instrumentation in several ways. The easiest is to be part of a surgical value analysis committee, if one exists in your facility. Generally this committee investigates the purchase of new technology and the instrumentation involved in these purchases. As part of that committee, your responsibility would be to investigate the information above and present your findings to the committee. Unfortunately, such committees do not exist in many facilities, and to obtain the information quickly you need to have close relationships with your customers and be able to educate them to your needs. Last, but by no means least, there is the reality that you may not receive any of this information until the instrument is presented to you the day of, or after, its initial use. In order to maintain the instrument and process it correctly, the next step is to obtain the information needed before you proceed. Once the information is obtained, you need to do any staff training indicated and, if there are unusual conditions for processing, advise the end user of these special circumstances such as (but not necessarily limited to): special sterilization cycles; avoidance of exposure to certain chemicals; requirements for sterilization of the item in an unassembled state, etc.
If, after investigating how to care for and maintain an item, you find you are unable to process it, you have not only a moral, but also an ethical, obligation to advise the end user. When you do so, make sure you have all of the information needed and have investigated alternatives. Often, a call to the manufacturer questioning their recommendations will result in additional information that allows you to process the item correctly.
All surgical instrumentation used daily to cut, dissect and clamp tissue and bone not only needs to be inspected after each use but must receive routine TLC in order to keep it functional, extend its useful life and reduce replacement costs. One way to do this is to establish a schedule to have complete trays and sets inspected by a repair company that will inspect, sharpen and realign instrumentation before it fails or becomes dull. A reputable company will charge only for the repairs made. Prior to establishing a schedule for the routine inspection of trays/sets, they must be identified in some fashion. Generally, a simple numbering system will do the job. Next, establish a schedule for the frequency of these inspections and a log to track the process and related costs. Initially the costs of this program may seem significant; however, over the course of a year and once all of the sets have been through the process, the ongoing costs should be below previous years' replacement costs. Using a mobile repair service is generally most efficient as it allows for immediate turn-around of the sets in your facility. Such a service also provides for better control of the frequency with which these trays/sets are done and gives you the ability to plan ahead.
Employee training also plays a major role in the maintenance of surgical instrumentation. The sterile processing department staff plays a vital role in the performance of instrumentation in many hospitals. In order to meet and exceed their customer's expectations they need to have the necessary tools, including training. Each time new instrumentation is introduced, the staff should be in-serviced. If indicated, there should be an opportunity for hands-on training by the manufacturer and a written procedure should be developed.
The key to optimum performance and an extended useful life of surgical instrumentation is to prevent potential problems before they occur. In order to do that, you need to know what is required to care for each instrument or piece of equipment that is processed; have the necessary tools to achieve the goal; perform routine inspection, testing and adjustments; and provide training to those individuals responsible for the processing of the instrumentation and/or equipment.
Teckla Ann Maresca, LPN, CSPDM, is sterile processing department manager at Saint Clare's Healthsystem in Denville, N.J. Nora Wikander, RN, CSPDM, is sterile processing department director at St. Joseph's Wayne Hospital in Wayne, N.J.