By Michael C. Murphy, ACSP
Anidentification (ID) system is a method or procedure used to identify a person oran object. More elaborate systems include those that identify via voice,fingerprint or retinal scan. In the healthcare arena, specifically in thecentral sterile processing department, ID systems help identify and classifyinstruments. They may not be as extravagant as a driver's license or somethingout of a James Bond movie, but they are ID systems nonetheless.
Several ID systems have been tried in the past. In the old days, everyone hada system unique to his or her situation. Pictures of instruments were filedaccording to the name vendors used for them. A picture of the instrument, itssize, product number and other pertinent data was placed on an inventory listand an index card, thus allowing the central service professional to compare thepicture and accompanying information with the instrument to determine thecorrect item was being ordered. When assembling trays, pictures listed inalphabetical order helped identify the proper instrument. When instruments orvendors changed, the picture books were updated.
As time went on these systems became cumbersome, since vendors changedconstantly and the actual product number for items varied from vendor to vendor.In some cases, two completely different instruments manufactured by separatevendors were called by the same name. In the late 1990s, the University of IowaHospitals and Clinics had surgeons evaluate basic instruments and discoveredthat the type of surgery each physician performed had a lot to do with whetheror not instruments were accepted. To a general surgeon, the instrument might beexactly the correct size, while an orthopedic surgeon found it much too small.On the other hand, an ophthalmology surgeon thought everything was quite large.Getting the correct item to a physician is a difficult task, and each time achange in vendors is made, the task becomes even more challenging. It getsincreasingly complicated as new instrument systems are developed and brought tothe marketplace.
Colored tape is another ID system that has been used to identify instrumentsets; yellow tape for labor and delivery instruments, blue tape for orthopedics,etc. This allowed central sterile processing staff to easily identifyinstruments sent for processing from specific areas of the hospital, andfacilitated the return of the correct instrument to the correct department. Somehospitals used different colored tape to identify certain instruments forcertain trays; instruments with white tape went in a major tray, for example.Still others color coded instruments by service, such as orthopedics, neurology,CT, etc. Tape identification systems varied from institution to institutiondepending on the issues involved in instrument cleaning and assembly. Someinstitutions did not use tape because of concerns that the instruments could notbe cleaned properly and that bacteria might not be completely removed from thenooks and crannies under the tape on the instrument.
In 1986, the University of Iowa Hospitals and Clinics developed its ownmethod of identifying instruments using an alpha-numeric system to aid staff whowere working with more than 12,000 unique items. When new instruments wereentered into the computer, each was given a unique number; instruments weregiven a number beginning with the letter T, and implants were given a numberbeginning with the letter X. When instruments were ordered from vendors, vendorswere instructed to send the instrument with its unique number permanently etchedon its surface. Staff simply had to verify the correct number had been etchedonto the instrument when it was received. Incorrectly marked items were sentback to the vendor.
Today, a technologically advanced bar code identification system isavailable, similar to what one sees in most retail shops. A small bar codeplaced on instruments identifies that item when it is run through a scanner.Anecdotal information suggests that this option, while convenient, can be rathercostly (greater than $1.23 per bar code). Once implemented, however, this systemis a great aid in instrument identification. The bar code system helps trackinstruments and provides useful information about how long the instrument was inservice, when it needed repair etc.
In the future, an optimal ID system would identify instruments through a barcode that was implanted in instruments by the manufacturer and which could beread from the same scanner. It would help identify instruments and implants andmake them unique by being able to track their use. It would aid in inventorycontrol and generally simplify the process. As an ID system, it still may notlive up to James Bond fame, but with this method each instrument would have itsown driver's license, and who knows what inventions may revolutionize the futurefor central sterile processing.
Michael C. Murphy, ACSP, is director of central sterilizing services forthe University of Iowa Hospitals and Clinics and is a past board member of theAmerican Society for Healthcare Central Service Professionals (ASHCSP).