Infection Control Today - 05/2004: Effective Management

Effective Management of Borrowed Instrumentation

By Richard P. Blasko, MBA, CSPDT, CRCST

Given the lofty expenditure on surgical supplies and declining reimbursement, many facilities that specialize in total joint replacements have had to resort to consignment of instrumentation on a case-by-case basis from the manufacturers of the implants. Surgeon preferences vacillate; it is not judicious to acquire all the various systems available in your sterile inventory.

Sterile processing managers are left with the prodigious task of managing a myriad of trays from multiple vendors flowing in and out almost daily. Lost or misplaced individual instruments or complete trays can prove a costly mistake. In addition, you must assure your customers that a consistently high standard of care is afforded to these trays to prevent cross-contamination.

To effectively manage this situation, you need to have an explicit yet simplistic policy to track all facets of a loaned item from receipt to return. Listed below is an illustration of a procedure that I have found successful in controlling loaned instrumentation.

Preparation of Policies and Procedures

A formal policy must be constructed that delineates each specific step involved and to whom the responsibility will fall to execute that procedure. A committee should be formed that embodies representatives from management, staff and the operating room. Input from all three perspectives will prove fruitful in assuring compliance and ultimate success.

Once a policy has been affirmed, the next step is to in-service not only your staff, but the representatives of the vendors that introduce the instruments to your facility. We supplied pre-printed index cards to each representative listing all management pager numbers and an abridged description of the policy requirements. Involvement of the vendors is imperative to the efficacy of your policy.

Receipt of Instruments

When instruments are brought to the department, vendors are required to contact one of the management staff listed on their index card. If no members of management are present, then the responsibility to check in the instruments shifts to the most senior technician. Before the instruments are accepted, the vendor is obligated to furnish the following information:

  • Date of surgery
  • Time of surgery
  • Name of physician
  • Number of trays
  • Vendor name
  • Color of plastic chip

A colored plastic chip is deposited in each tray by the vendor designating that tray for a specific surgery. The aforementioned information is also transcribed on a large dry-erase board. The trays are sent to the decontamination area for washing and disinfection. Do not allow trays to bypass the decontamination process or you will compromise the sterility of the instruments, as well as the integrity of your department.

Assembly and Sterilization of Instruments

After decontamination, the trays are ready to be assembled for sterilization. The technician wrapping the trays will remove the color chip and transfer the necessary information from the dry-erase board to the sterilization tape. In addition, the trays are numbered 1 of total, 2 of total, etc. This guarantees that the required trays will remain intact for the surgery for which they were intended. A red sticker labeled LOANER is affixed to the outside tape to further alert staff of the trays status. Finally, the sterile trays are transported to the sterile storage area and remain on the transport rack until requested by surgery.

Return of Instrumentation

After use, the trays are decontaminated and placed on a holding rack awaiting repossession by the vendor. When the vendor returns, they are required to examine the instruments with management or a senior technician. Any discrepancies must be noted at this point by the vendor. Once the instrumentation leaves your department, the process is finalized. The corresponding information may be removed from the dry-erase board.

By tracking loaned instrumentation by use of colored chips and a dry-erase board we have realized a tangible reduction in incidents concerning borrowed equipment. Our department has managed up to 40 separate instrument trays designated for eight different surgeries in one day. Without a concrete, effective policy in place, coordinating such a task would be difficult, at best.

Richard P. Blasko, MBA, CSPDT, CRCST, is supervisor of surgical processing and support services at Akron General Medical Center in Akron, Ohio. In addition, he is the instructor of the sterile processing/ central service course at the University of Akron.

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