Going Boldly into the 21st Century and Beyond
New Technology Will Revolutionize Central Service and Sterile
By Bryant C. Broder, CSPDT, ACSP and Michael Murphy, ACSP
We were definitely two of those kids in the '60s that couldn't get enough Star Trek or science fiction. Most people didn't believe we'd ever become a society where tri-corders and communicators were used. But, look at us now! We use digital cell phones, Palm organizers, and GPS units in our cars. Society is looking more like Star Trek every day, and the CS/SP department should be no exception. Several professionals in the field recently gathered at an American Society for Healthcare Central Service Professionals (ASHCSP) meeting for a "brain drain." The discussion centered around new technology: what is currently available, what might be on the drawing board, and what would be the best thing since John J. Perkins for the CS profession.
In the 21st century, computer technology will continue to play a greater role in instrument processing. Consider this: a chip, barcode, or data cell will be placed in or on surgical instruments, allowing that device to be tracked and identified via strategically placed computer/optical scanners. This will help to eliminate placing the wrong instruments on a tray and improve staff's ability to identify different instrument patterns. It will allow staff to know when an instrument/tray needs to go out for repair and how many times an item was used. A tray run under the computer/optical scanner can identify missing items and/or incorrect items from the tray list. The computer-generated data will further indicate when an instrument was purchased and how long it has been in use. This tracking feature will help lower overall instrument costs and will also solve problems that have plagued the industry for years, such as lost trays. Trays won't get lost, as they will be traceable through the last location where they were scanned. Staff badges can also be tracked using this type of technology, making it easy to identify who left at the same time as the tray.
Using new technology also means encountering new user issues. Instruments will be more complex and more difficult to clean and process. Increased use of robotics and computers in the OR will require changes in the cleaning process. Fewer instruments will be used in surgery, but the cost of instruments will increase. Current instrument cleaners will have built-in computers that will enhance the performance of washer decontaminators and the cycles they process. A scanner over the door of the washer will identify what is in the load and determine how the cycle is run. Records of this process will be documented so tray processing can be traced back to an individual cycle. These same computer/optical scanners will analyze the instruments as they come out of the turbosonic washing chambers. They will scan for proteins and other gross contaminants to ensure the instruments are clean and that the bioburden has been significantly reduced to allow for safe handling. Blood and body fluids will be managed at the point of surgery. Self-contained suction devices will mange the fluids, provide digital readouts for volume record keeping, and empty the containers after surgical procedures, thus eliminating staff exposure to the hazard.
In the area of sterilization, the entire process--including recall--will be automated. Biological data will be recorded, and a system will automatically engage in the event of a positive biological reading. Computers will indicate the exact location of the trays in question, identify which patients may have been infected, and will notify the infection control and OR nursing departments. Other aspects of sterilization will be affected by new technology as well. Tedious paper record keeping will be replaced with an efficient and secure system for sterilization documentation. Sterilizers will have the capacity to be run from remote locations; if any parameter does not meet the proper sterilization restrictions, that load will not be released without intervention from a supervisor. This will eliminate guesswork on the part of the operator. Scanners over the door of the sterilizer will run the appropriate load parameters based upon the contents of the sterilizer cart, and will record everything that is being run in that load. The cycle will not be released from the sterilizer until the load has been determined to be sterile via parametric release. Sterilizers themselves may change. Look for sliding doors, one-lever doors, different chamber sizes to facilitate container systems, and perhaps one day, a sterilizer that is a combined steam, ETO, plasma, or vapor unit.
As the number of medical lawsuits continues to rise, it has become increasingly important to demonstrate the ability to track instruments. By monitoring and digitally recording the process from the OR to decontamination to the sterilizer and finally to the patient, technology can legally verify that the process meets the standards for sterilization. It will also help to ensure that processing is being done safely and correctly.
As long as the world continues to change, and the number of new strains of resistant bacteria continues to flourish, CS/SP professionals will need to make adjustments in how items are cleaned and processed. We may be required to have more than one time-standard policy for sterilization parameters, depending upon the type of surgery being performed. CJD and anthrax will no longer be the threatening new diseases, but other agents that may be even more resistant to death by steam. As new technology enters the market it is incumbent upon us to be knowledgeable about it so we can determine the best product/procedure for the situation.
Lastly, in looking ahead, the workforce will continue to decline in size as automation increases in the CS/SP department. Staff certification and education will become even more important. Federal regulations will continue to have a profound effect on hospital costs and how things are done. In the past 10 years many of the things that were once held sacred have changed: washer sterilizers have been replaced by washer decontaminators, gas sterilization has been reduced, and new products have taken their place. OPA has reduced the soak time, and scope washers have become commonplace. We will most assuredly see significant change over the next 10 years as surgery becomes automated. Will 21st century surgery and related procedures be as advanced as those seen on Star Trek? No one knows for sure, but we can safely bet that the CS/SP professional will lead the way as we "boldly go where no one has gone before!"
Bryant C. Broder, CSPDT, ACSP, is president of the American Society for Healthcare Central Service Professionals (ASHCSP) and manager of surgery processing at Saint Mary's Mercy Medical Center in Grand Rapids, Mich. Michael Murphy, ACSP, is the Region 8 board representative for ASHCSP and manager of CSS for University of Iowa Health Care.