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Can you ensure to all patients that every instrument used in their surgical procedure can be tracked back to the sterilizer and load in which it was processed? ANSI/AAMI-recommended practices and industry standards for sterilization support the notion that all items used in a procedure must be verified for sterilization and have the ability to be tracked directly to the patient upon which they were used. This is important from an infection control standpoint as well as a legal one. If a biological indicator showed a positive result after the release of instruments and a facility had to recall items, a tracking system would allow the capability for clinical staff to know for certain which patients had items used from the “suspect” load. In addition, it provides peace of mind that your facility is compliant with industry standards and taking the correct course of action to prevent surgical infections.
One approach to instrument tracking is utilizing an automated computer system. Computerized instrument tracking is efficient and effective in tracking instruments through the entire processing cycle using bar code-scanning technology to facilitate tracking from decontamination through sterilization. The one downside if any, to these systems is the cost to purchase and implement the system. With budgets tightening, many clinical directors and infection prevention specialists find themselves wanting an automated system but not having the money available. This, however, is not an excuse for not having an instrument tracking system in place. There are a number of inexpensive alternatives and a facility does not need to spend thousands of dollars to comply with industry standards and recommended practices.
Instrument tracking cards provide one such alternative to automated tracking systems. While they do not provide all the benefits of these systems, they are an inexpensive yet effective product for tracking sterilized instruments directly to the patient upon which they were used. Before sterilization, the nurse or technician responsible for sterilizing instruments applies a load record label to the instrument tracking card. This label records the load and sterilizer information. They then attach to the card to all peel packs, wrapped items and containers with indicator tape and run them in the sterilization process. When the instruments arrive to the operating room, the information on the card is completed, removed from the set and put in the patient’s records.
Facilities can also create and implement their own method of instrument tracking based on their resources and needs. For example, Parkridge Surgery Center located in Columbia, S.C., uses a unique system to ensure sterility and track instruments back to their patients with minimal cost to the facility.
Since Parkridge Surgery Center utilizes mechanical, biological and internal/external chemical indicators (CIs) as part of its sterility assurance program, the facility has incorporated this into its tracking system. Once the sterilized package has been opened (just prior to surgery), the internal indicator strip is removed from the pack by a technician or nurse who will get the sterilizer number, load number, year and date of sterilization and item identification from the pack’s load record label and then record this information on the back side of the strip. The strip is then handed to an OR nurse who is responsible for placing the indicator in an envelope with the patient’s sticker affixed to the outside; this is added to the patient’s record and kept on file.
If monitoring your packs with CIs that are not conducive to writing on their back side, all pertinent information may be recorded on the envelope itself. By visually inspecting every indicator and compiling this information, Parkridge Surgery Center has the ability to track every item that was used during a patient’s visit directly back the specific sterilized load. This provides peace of mind that sterility assurance has been monitored and documented in compliance to recommended practices.
Whether using an automated tracking system, manual tracking system or creating your own method of instrument tracking, the steps toward implementing them into your facility remain the same. The most critical step is system education and training. It is important that each member of the surgical services staff has a knowledge and understanding of the instrument tracking system being put in place. No matter the method, all the needed information must be gathered for record including: sterilizer number, load number and date. Recording this data allows the ability to track an instrument from the patient to the day, the load and the sterilizer it was processed. A post-implementation assessment should also be performed. Doing this will provide your facility with important feedback from your staff. Each surgical suite operates differently and will put its own creative twist on a system. By performing a post-implementing assessment on your instrument tracking program you open the door to becoming more efficient and effective within your center.
Implementing an instrument tracking program will assist every facility in providing superior patient care to its patients. By having a system in place, facilities can be confident in the infection prevention measures they take and their work toward eliminating surgical infections. Compliance with recommended practices also protects centers legally, proving that industry standards were followed in every case processed. Most importantly, it allows clinical personnel to promise their patients that every instrument used in a procedure can be tracked through the sterilization process.
Lisa Waters-Davis, RN, is the clinical director at Palmetto Health Parkridge Surgery Center. As a member of the ASC Association and the South Carolina Ambulatory Surgery Center Association, Waters-Davis has devoted much of her professional and personal time to infection prevention and eliminating surgical infections.