Infection Control Today - 03/2003: Success Story

Newborn Security Monitors Lead to the Adoption of a New Sterilization Technology at The Woman's Hospital of Texas

By Joyce Dickerson

Members of The Woman's Hospital of Texas sterile processing staff are (back row, L to R) LB Gardner, John Edwards, Sharon Jackson, Gloria Parish; (front row, L to R) Kimberly Jiles, Joyce Dickerson, Joyce McQueen.

Infant abduction from a hospital nursery is an infrequent yet devastating event to all involved. Increased media attention about child abductions and a growing awareness about the need to protect newborns have spurred healthcare facilities around the country to take extra measures to ensure the safety of infants and their families. At The Woman's Hospital of Texas, a Houston-based medical facility devoted exclusively to women's healthcare, the adoption and deployment of sophisticated, miniature security transponders was a key step in guaranteeing protection for the 8,000-plus babies born at the facility each year.

The innovative safety devices are attached to each infant upon delivery and are designed to prevent unauthorized removal of babies from the facility by signaling an alarm if moved beyond established boundaries. While the devices were easily and successfully integrated into the nursery's daily clinical practice, their sophisticated electronics and specialized reprocessing requirements created a separate, costly problem.

Compounding Limitations of Current Sterilization Practices

The sterile processing department (SPD) at The Woman's Hospital of Texas handles the instrument processing needs of the 275-bed facility, which includes 30 ante-partum, 30 labor and delivery and 98 neonatal intensive care unit (NICU) beds. The department also serves as a backup for the hospital's eight satellite clinics. For more than 26 years, the department used ethylene oxide (EtO), as well as steam sterilization to process its medical devices and surgical instruments. However, the department identified several limitations with the systems.

For example, while EtO was compatible with many of the hospital's heat- and moisture-sensitive instruments, its 16-hour cycle time negatively affected the availability of sterilized devices and occasionally resulted in delayed surgeries. Furthermore, because EtO is a carcinogen, costly monitoring devices were required to ensure employee and patient safety. Despite concerns about long cycle times and the safety issues associated with EtO, the department had been unable to justify the cost of converting to a safer system.

These problems were exacerbated with the adoption of the infant transponders, which require sterilization after each use. Manufacturer guidelines for the sterilization of the delicate infant safety devices warned against the use of EtO or steam sterilization, and endorsed only gas plasma sterilization. The department, not equipped to sterilize the devices, was forced to send monitors to the manufacturer for reprocessing. Outsourcing was expensive--$11 for each monitor--and sterile monitors often were not returned for two weeks, requiring the department to maintain a large inventory of the expensive devices. In addition, the logistics involved in packaging and shipping the devices to the manufacturer's New Jersey facility and monitoring their return placed an added burden on department staff.

These factors also greatly added to operating expenditures, forcing the department to seek a safe, fast and cost-effective sterilization technology that could be used for the security devices and positively contribute to overall instrument processing practices.

A New Sterilization Alternative

In an effort to alleviate the expense and inconvenience of outsourcing infant safety devices, the SPD began researching alternative sterilization techniques. Department staff learned that the manufacturer of the security devices utilized a low-temperature hydrogen peroxide gas plasma sterilization system [STERRAD 100S Sterilization System from Advanced Sterilization Products (ASP)] to reprocess the infant monitors. The manufacturer had completed cycle and validation procedures for the safety devices using the hydrogen peroxide gas plasma system. Upon review, department personnel determined they could cost-effectively sterilize the monitors in-house using the same system, and they began the process of collecting supporting data to present to hospital administrators in order to justify the capital expenditure.

To ensure that the hydrogen peroxide gas plasma system would meet hospital needs and decrease costs, the SPD, along with the infection control, security, surgery and nursery departments, outlined several criteria, determining that the new sterilization system must be safe, cost-effective, environmentally friendly, fast and compatible with a wide range of instruments beyond the infant safety monitors

Confident that the hydrogen peroxide gas plasma system met these criteria, the SPD approached hospital administrators about purchasing the new system. In May 2002, the department received approval and acquired a STERRAD 100S System.

Immediate Benefits

Once installed, the hydrogen peroxide gas plasma sterilization system made an immediate, positive impact on the department and patient care. Because of the system's fast, 55-minute turnaround time and terminal sterilization capability, concerns about a shortage of available sterile infant safety monitors were alleviated. Furthermore, the department no longer had the burden of packaging the devices for shipment to the manufacturer for sterilization and tracking their return.

Most importantly, department costs were significantly reduced. By eliminating expensive outsourcing for the devices, the department was able to project an annual saving in excess of $118,000, more than covering the cost of the sterilization system in just the first year.

In addition, the hydrogen peroxide gas plasma system's high level of materials compatibility enabled the department to sterilize most of the hospital's heat- and moisture-sensitive instruments previously processed using EtO, thus eliminating EtO use at the facility. The system's fast cycle time also has improved instrument processing and reduced surgical delays caused by a lack of sterile instruments. The removal of EtO also has eliminated safety concerns surrounding its use and the need for mandatory employee monitoring, further contributing to the department's cost savings.

Overall, the department's transition to the STERRAD System was seamless and the facility experienced no downtime. Integration was greatly facilitated by the system's minimal installation requirements and the fact that no special equipment, such as heat boosters, plumbing, vents or drains is needed.

Hospitals are continuously challenged to provide exceptional patient care while facing increasingly tight budgets. For many hospital administrators, the constant pressure to reduce costs limits the ability to integrate new technology, such as sophisticated security systems, that can enhance patient care and safety. The adoption of the STERRAD Sterilization System has allowed The Woman's Hospital of Texas to dramatically reduce costs while providing the best patient care. The hospital is proud of its pioneering roles in both infant safety and instrument processing and hopes that telling its story will help other facilities faced with similar challenges.

Joyce Dickerson is sterile processing manager at The Woman's Hospital of Texas.

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