By Bryant C. Broder, CSPDT, ACSP and Michael Murphy, ACSP
We were definitely two of those kids in the '60s that couldn't get enoughStar Trek or science fiction. Most people didn't believe we'd ever become asociety where tri-corders and communicators were used. But, look at us now! Weuse digital cell phones, Palm organizers, and GPS units in our cars. Society islooking more like Star Trek every day, and the CS/SP department should be noexception. Several professionals in the field recently gathered at an AmericanSociety for Healthcare Central Service Professionals (ASHCSP) meeting for a"brain drain." The discussion centered around new technology: what iscurrently available, what might be on the drawing board, and what would be thebest thing since John J. Perkins for the CS profession.
In the 21st century, computer technology will continue to play a greater rolein instrument processing. Consider this: a chip, barcode, or data cell will beplaced in or on surgical instruments, allowing that device to be tracked andidentified via strategically placed computer/optical scanners. This will help toeliminate placing the wrong instruments on a tray and improve staff's ability toidentify different instrument patterns. It will allow staff to know when aninstrument/tray needs to go out for repair and how many times an item was used.A tray run under the computer/optical scanner can identify missing items and/orincorrect items from the tray list. The computer-generated data will furtherindicate when an instrument was purchased and how long it has been in use. Thistracking feature will help lower overall instrument costs and will also solveproblems that have plagued the industry for years, such as lost trays. Trayswon't get lost, as they will be traceable through the last location where theywere scanned. Staff badges can also be tracked using this type of technology,making it easy to identify who left at the same time as the tray.
Using new technology also means encountering new user issues. Instrumentswill be more complex and more difficult to clean and process. Increased use ofrobotics and computers in the OR will require changes in the cleaning process.Fewer instruments will be used in surgery, but the cost of instruments willincrease. Current instrument cleaners will have built-in computers that willenhance the performance of washer decontaminators and the cycles they process. Ascanner over the door of the washer will identify what is in the load anddetermine how the cycle is run. Records of this process will be documented sotray processing can be traced back to an individual cycle. These samecomputer/optical scanners will analyze the instruments as they come out of theturbosonic washing chambers. They will scan for proteins and other grosscontaminants to ensure the instruments are clean and that the bioburden has beensignificantly reduced to allow for safe handling. Blood and body fluids will bemanaged at the point of surgery. Self-contained suction devices will mange thefluids, provide digital readouts for volume record keeping, and empty thecontainers after surgical procedures, thus eliminating staff exposure to thehazard.
In the area of sterilization, the entire process--including recall--will beautomated. Biological data will be recorded, and a system will automaticallyengage in the event of a positive biological reading. Computers will indicatethe exact location of the trays in question, identify which patients may havebeen infected, and will notify the infection control and OR nursing departments.Other aspects of sterilization will be affected by new technology as well.Tedious paper record keeping will be replaced with an efficient and securesystem for sterilization documentation. Sterilizers will have the capacity to berun from remote locations; if any parameter does not meet the propersterilization restrictions, that load will not be released without interventionfrom a supervisor. This will eliminate guesswork on the part of the operator.Scanners over the door of the sterilizer will run the appropriate loadparameters based upon the contents of the sterilizer cart, and will recordeverything that is being run in that load. The cycle will not be released fromthe sterilizer until the load has been determined to be sterile via parametricrelease. Sterilizers themselves may change. Look for sliding doors, one-leverdoors, different chamber sizes to facilitate container systems, and perhaps oneday, a sterilizer that is a combined steam, ETO, plasma, or vapor unit.
As the number of medical lawsuits continues to rise, it has becomeincreasingly important to demonstrate the ability to track instruments. Bymonitoring and digitally recording the process from the OR to decontamination tothe sterilizer and finally to the patient, technology can legally verify thatthe process meets the standards for sterilization. It will also help to ensurethat processing is being done safely and correctly.
As long as the world continues to change, and the number of new strains ofresistant bacteria continues to flourish, CS/SP professionals will need to makeadjustments in how items are cleaned and processed. We may be required to havemore than one time-standard policy for sterilization parameters, depending uponthe type of surgery being performed. CJD and anthrax will no longer be thethreatening new diseases, but other agents that may be even more resistant todeath by steam. As new technology enters the market it is incumbent upon us tobe knowledgeable about it so we can determine the best product/procedure for thesituation.
Lastly, in looking ahead, the workforce will continue to decline in size asautomation increases in the CS/SP department. Staff certification and educationwill become even more important. Federal regulations will continue to have aprofound effect on hospital costs and how things are done. In the past 10 yearsmany of the things that were once held sacred have changed: washer sterilizershave been replaced by washer decontaminators, gas sterilization has beenreduced, and new products have taken their place. OPA has reduced the soak time,and scope washers have become commonplace. We will most assuredly seesignificant change over the next 10 years as surgery becomes automated. Will21st century surgery and related procedures be as advanced as those seen on StarTrek? No one knows for sure, but we can safely bet that the CS/SP professionalwill lead the way as we "boldly go where no one has gone before!"
Bryant C. Broder, CSPDT, ACSP, is president of the American Society forHealthcare Central Service Professionals (ASHCSP) and manager of surgeryprocessing at Saint Mary's Mercy Medical Center in Grand Rapids, Mich. MichaelMurphy, ACSP, is the Region 8 board representative for ASHCSP and manager of CSSfor University of Iowa Health Care.