Sterilized Containment Systems

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Instrument Sets
Standardization and tracking are crucial to instrument management

By R. Michael Appleby

"Instrument set" is a broad term and could be used to describe a single surgical instrument needed for a simple task, a disposable instrument set used for a specific procedure in the ER or on the floor, or a specialty set of instruments used in the OR, ranging from a few handheld surgical instruments to over a hundred different patterns.

Surgical instruments are organized into sets to meet specific requirements determined by the intended use. A single splinter forceps could be classified as an instrument set when used in the office or ER to remove a splinter. A disposable instrument set might prove to be cost effective and eliminate lost or stolen instruments in an ER suture tray. The OR, outpatient suites, or labor and delivery rooms require instrument sets based on the surgical procedures to be performed therein.

Each set should contain only those instruments required to perform the specific task for which the set was created. Instrument sets may also contain basins, medicine cups, four-by-fours, and other items that are needed each time the set is used and that can be sterilized together.

Every effort should be taken to standardize specific instrument sets. Instead of having "Dr. Smith's Minor Set" and "Dr. Jones' Minor Set," there should be one Minor Set. If Dr Smith or Dr Jones asks for additional items, it is more cost effective to single-wrap these items and pick them for the specific doctor's case. This eliminates initial purchases, processing time, and charges as well as repair costs. Specialty charge nurses should work with the physicians using the trays to get agreement for standardization.

Once the instrument set contents are determined, a "pick list" should be created listing a vendor catalog number, item description, quantity, and unit of measure. In addition, there should be spaces for processing to fill in quantities that were processed for the person opening the tray to fill in quantities found in the set, for the person completing the procedure to fill in quantities for items being returned to processing, and for processing to fill in quantities for instruments returned. Each person should initial the quantities so that "missing" instruments can be traced to a specific person and located. The pick list should stay with the instrument set throughout its travels from processing to department of use to processing department. The use of a pick list with the entries for each time the instrument set is handled is the only way to eliminate lost instruments.

One person should have authority to change the pick list contents once everyone involved has agreed to the change. This will eliminate confusion, duplication, and the unnecessary expense of having too much or not enough in an instrument set. Before creating a "new" instrument set, every effort should be made to determine if an existing one will accomplish the goals for which the set is being created. A new instrument set should be created only when an existing set contains too few or too many instruments.

Another challenge is having the correct number of instrument sets for a specific time period--generally a day's procedures. It is important to have enough instrument sets to cover your daily needs without placing undue stress on the processing department to turn sets over or having sets stay on the shelf. Use the pick lists and work with your surgical instrument sales representative to determine correct levels based on daily demand to direct assets from an overused set to an underused set.

Surgical instrument sets are one of the largest assets in the operating arena. Generally, there are too many non-standardized sets in use. Working together with your charge nurses, surgeons and instrument sales representatives to manage these assets can lead to less sets, more standardization, and lower acquisition and repair costs associated with your surgical instruments.

R. Michael Appleby is an Instrument Asset Management Consultant for Allegiance Healthcare Corporation, V. Mueller in McGaw Park, Ill. He has been associated with V. Mueller since 1969.

Sterilized Containment Systems

Case Medical® offers customization services along with its universal line of SteriTite® sealed containers and MediTray® products. Case's team of product specialists visit facilities to help staff find solutions to better sterilize, store and protect surgical devices and instruments. According to Case, customers have saved thousands of dollars in repair and replacement expenses through better organization and use of protective inserts.

For more information contact Case Medical, Inc.
(201) 313-1999 

Sterilization in a Hurry

Keep instruments sterile with the STATIM system by SciCan. According to the company, STATIM's removable sterilization chamber acts as a sterile transportation system between autoclave and patient. Cassette remains closed until circulator opens it at the operative site. Fast steam injection system allows autoclave of even the most delicate instruments without fear of damage. A sterilization cycle of just over 9 minutes allows staff to sterilize instruments between or during procedures.

For more information contact
SciCan, Inc.
(800) 572-1211

Instrument ID tags

Resin bonded tags, shaped and drilled for use in tray identification procedures, help staff maintain organization. Tags may be used with bar code labels or hand-written notes. All instruments remain with the sterilization basket throughout collection, decontamination and sterilization processes. Tags are X-ray detectable and come attached with stainless steel rings or special nylon ties.

For more information contact
HealthMark Industries (800) 521-6224

Safety Scalpel

Designed by a heart surgeon and safety engineer, DeRoyal's Retractable Safety Scalpel features a retractable, stainless steel blade activated with one hand during surgery, and recessed for use among personnel. An audible click identifies blade position, while "biohazard red" color is easily seen on safety zone in sterile field. Slip-resistant grips and slim-comfort styling allow surgeons to use any cutting position desired, according to the company. Meets OSHA standards as defined in the Nov. 1999 directive advocating the use of sharps devices engineered to reduce the risk of exposure.

For more information contact De Royal Industries
(800) 251-9864

Genesis Containers Program

Genesis Sterilization Container Systems are backed by a lifetime warranty for materials and workmanship, and are designed to provide excellent sterility maintenance and instrument protection, the company says. Genesis Maintenance and Repair Program offers authorized repair service for Genesis containers. Repairs can be made at the company's facilities or on your premises through On-Site® service.

For more information contact
Allegiance Healthcare Corp.
(800) 227-3220

See-Through Storage for Endoscopes

Custom-designed for Karl Storz endoscope and instrument sets, each tray features silicone holding bars to secure components firmly in place. See-through lids allow easy identification without breaking the sterile seal. According to the company, each tray is made from rugged, advanced plastic polymers to protect endoscopes during transport, storage and steam or ethylene oxide sterilization.

For more information contact
Karl Storz Endoscopy America, Inc. (800) 421-0837

Protect and sterilize delicate instruments with PST trays

PST trays are manufactured with a "pebble-like" surface, which raises the silicone mat from the tray surface, preventing adhesion of the mat to the surface of the tray and ensuring for proper penetration of steam between mat and tray. PST instrument trays are manufactured with an advanced medical grade plastic that is compatible with most sterilization protocols. According the company, PST trays protect expensive surgical instruments during sterilization, storage and transportation and help to avoid costly repairs.

For more information contact Plastic Sterilizing Tray Company
(800) PST-TRAY

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