Beyond Testing and Repairing Instruments
By Teckla Ann Maresca, LPN, CSPDM and Nora Wikander, RN,
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
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
- 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
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
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,