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By Teckla Ann Maresca, LPN, CSPDM and Nora Wikander, RN,CSPDM
A big challenge to today's healthcare facilities is to provide the bestpossible service to our customers while staying within strict financialconfines. As budgets dwindle, we face an increasing need to scrutinize ourdepartments for ways to improve our processes while maintaining and/or reducingcosts. Often, the initial solution employs a form of "tunnel vision"that eliminates those tasks or processes that do not appear to have a valueequal to the costs associated with them. Performing routine, preventivemaintenance 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 ofsurgical procedure delays resulting from instruments not functioning properly,the increased cost to replace improperly cared-for instruments, and the ultimateimpact on customer service. Further, it must be understood that surgicalinstrumentation and/or equipment is a major portion of a hospital's assets.
Previous articles have discussed the routine testing and inspection ofsurgical instrumentation. In this article, we will concentrate on the process ofmaintaining surgical instrumentation as opposed to the actual tasks associatedwith the process such as testing, cleaning, inspection and sterilization. Aprocess that is based on preventive maintenance and knowledge of theinstrumentation being processed will avoid unnecessary costs and repairs,improve functionality and, ultimately, improve customer satisfaction.
Maintenance of instrumentation begins, in some instances, before theinstrument is purchased. It requires a cooperative effort between the processorand the end user with open lines of communication. When anticipating thepurchase of advanced technology and/or instrumentation, consideration must begiven to the complexity of cleaning the instrument(s), the actual sterilizationprocess, limited reuse information and related costs of disposable accessoriesneeded to care for the instrument(s) or provide for its routine use. Afterlooking at these issues, it may be determined that additional research and analternative may be the best approach. At this point, there are probably severalthings going through the reader's mind, such as:
Much of the new instrumentation related to changing technology is, by nature,extremely complex. Among the issues to consider are if the item can beadequately reprocessed (cleaned and/or sterilized) by your facility. Among thequestions that must be answered are:
As you can see, unless these questions can be answered positively, you cannotmaintain the instrumentation in question. To your advantage, having theseanswers prepares you to maintain and process the instrument from the day itarrives.
You can be in the loop prior to the purchase of instrumentation in severalways. The easiest is to be part of a surgical value analysis committee, if oneexists in your facility. Generally this committee investigates the purchase ofnew technology and the instrumentation involved in these purchases. As part ofthat committee, your responsibility would be to investigate the informationabove and present your findings to the committee. Unfortunately, such committeesdo not exist in many facilities, and to obtain the information quickly you needto have close relationships with your customers and be able to educate them toyour needs. Last, but by no means least, there is the reality that you may notreceive any of this information until the instrument is presented to you the dayof, or after, its initial use. In order to maintain the instrument and processit correctly, the next step is to obtain the information needed before youproceed. Once the information is obtained, you need to do any staff trainingindicated and, if there are unusual conditions for processing, advise the enduser 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 youare 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 theinformation needed and have investigated alternatives. Often, a call to themanufacturer questioning their recommendations will result in additionalinformation that allows you to process the item correctly.
All surgical instrumentation used daily to cut, dissect and clamp tissue andbone not only needs to be inspected after each use but must receive routine TLCin order to keep it functional, extend its useful life and reduce replacementcosts. One way to do this is to establish a schedule to have complete trays andsets inspected by a repair company that will inspect, sharpen and realigninstrumentation before it fails or becomes dull. A reputable company will chargeonly for the repairs made. Prior to establishing a schedule for the routineinspection of trays/sets, they must be identified in some fashion. Generally, asimple numbering system will do the job. Next, establish a schedule for thefrequency of these inspections and a log to track the process and related costs.Initially the costs of this program may seem significant; however, over thecourse of a year and once all of the sets have been through the process, theongoing costs should be below previous years' replacement costs. Using a mobilerepair service is generally most efficient as it allows for immediateturn-around of the sets in your facility. Such a service also provides forbetter control of the frequency with which these trays/sets are done and givesyou the ability to plan ahead.
Employee training also plays a major role in the maintenance of surgicalinstrumentation. The sterile processing department staff plays a vital role inthe performance of instrumentation in many hospitals. In order to meet andexceed their customer's expectations they need to have the necessary tools,including training. Each time new instrumentation is introduced, the staffshould be in-serviced. If indicated, there should be an opportunity for hands-ontraining by the manufacturer and a written procedure should be developed.
The key to optimum performance and an extended useful life of surgicalinstrumentation is to prevent potential problems before they occur. In order todo that, you need to know what is required to care for each instrument or pieceof equipment that is processed; have the necessary tools to achieve the goal;perform routine inspection, testing and adjustments; and provide training tothose individuals responsible for the processing of the instrumentation and/orequipment.
Teckla Ann Maresca, LPN, CSPDM, is sterile processing department managerat Saint Clare's Healthsystem in Denville, N.J. Nora Wikander, RN, CSPDM, issterile processing department director at St. Joseph's Wayne Hospital in Wayne,N.J.