THIS WEEK'S ARTICLES
Performance of Microsurgical Instruments is Key to Successful Surgery - Sponsored Content
Finding a Needle (or Microsurgical Instrument) in a Haystack
Hospital's airport-style scanning process saves $35,000 worth of surgical tools from OR trash.
By nature of their size, microsurgical instruments are more likely to get lost in the shuffle of OR turnovers than larger instruments. In a worst case scenario, they might be accidentally thrown away and lost in the waste stream of a facility.
Lost instruments were a problem in the main OR at University of Iowa Hospitals & Clinics in Iowa City, which led to the formation of a multidisciplinary team to pinpoint why it was happening and how to take corrective action.
"We determined that some of our instruments were being accidentally thrown away during the OR clean-up process," Nurse Manager Anna Carpenter, MSN, RN, CNOR, tells UI Health Care's publication The Loop. Ms. Carpenter and her team viewed the problem as not just about the financial cost of lost instruments, but also about patient and staff safety if needed instruments were unavailable.
The facility's solution was a prime example of effective out-of-the-box thinking. It implemented a scanning system much like what a traveler would encounter while going through security to board a flight at any airport. Now, after each surgery, bags of trash are removed from the OR, run through environmental services, placed on a conveyor belt and scanned. Each bag is numbered to identify the room and surgery from which it originated. If the scan detects an instrument, it is documented, and a nurse is called to identify it and process it correctly through the sterile processing department.
The innovative idea recovered $35,000 worth of lost instruments in its first nine months. "When you think about some of the instruments we use in certain procedures, they may be one or two of a kind in terms of the supply we have here," says Ms. Carpenter. "If an emergency pops up and we're missing that tool, we'd be hard-pressed to provide the necessary care to that patient. This process and technology allow us to be there for our patients. It's also a reminder to be diligent, follow best practices for disposal of trash and sharps, and to think creatively when confronted with a problem."
Residual Bioburden Could Affect Precision and Safety of Microsurgical Instruments
Researchers investigate a ceramic coating that could greatly reduce the adherence of contaminants.
A recent study examined the coating of microsurgical instruments and their relationship to residual bioburden and surgical precision.
German researchers publishing in Journal of Reconstructive Microsurgery undertook their study in the interest of furthering progress in the field of microsurgery to allow more detailed reconstructions of the smallest tissue structures. The study was guided by the idea that when microsurgical instruments are left with biological residue after coming into contact with body fluids or tissue, surgical precision is compromised. The researchers theorized that designing residue-free instruments would improve surgical precision and enhance patient safety.
They designed a ceramic coating that they say exhibits self-cleaning surface properties on coated titanium specimens. "A titanium surface was modified by blasting technology and electropolishing, followed by applying a high-performance ceramic and sol-gel finish layer," they write. They then investigated the resulting cell-repellent properties and cytotoxicity of the surface.
The researchers found that the ceramic coating reduced the adherence of cells, blood, bacteria and tissue on titanium microsurgical instruments. It increased the hydrophobic character of the titanium surface and produced fluid and cell-repellent properties, including a 74.1% reduction in residual Staphylococcus aureus and a 62.9% reduction in erythrocyte adherence. When they dipped a coated titanium microforceps in human whole blood, they found a 46.1% reduction in blood adherence. "Cyto- and hemocompatibility was guaranteed in direct and indirect tests," they add.
"Innovatively coated instruments could contribute to increased precision during microsurgical interventions and optimized medical operation routines in the future," they conclude. For facilities that use microsurgical instrumentation, the results indicate that coatings could become a key product differentiator moving forward into future purchases.
Performance of Microsurgical Instruments is Key to Successful Surgery
Surgeons look for ease of use, consistency and peak condition for their instruments.
Surgeons need to have the confidence that their instruments are in top condition as they perform surgeries. This is especially true of the delicate microsurgical instruments used for surgeries that require pinpoint accuracy because of the nature of the procedures. Rhinology and sinus surgery are just some examples of surgery that require consistency, ease of use and peak conditions for the microsurgical instruments required.
Additionally, these instruments need to be cleaned and maintained to the highest level possible, and that requires a total team effort in partnership with the sterile processing department. Not having the preferred instruments on hand in the proper condition diminishes the surgeon's options.
Open communication is also important as the instrument care experts take the lead on sterilization and proper care of the microsurgical instruments. Listening to the surgeon's preferences and feedback ultimately helps make the best decisions about what to purchase and keep on hand.
Special trays also keep these delicate instruments in good working order. Training to keep everyone replacing the instruments to their assigned locations will help with wear and tear. An excellent solution for the necessary inspection of these microsurgical instruments is installing a large, lighted magnifying glass as reprocessing technicians are tasked with testing the grasping and cutting performance of each tool before use.
Most surgeons prefer to work with instrumentation they used during residency, primarily because these tools had been vetted for peak performance and many surgeons have used them successfully. However, that does not mean they are opposed to new options – or at least giving them a trial run. Ultimately, it is the quality and care of the instruments that will sway the decision to use them.
Note: For more information please go to https://www.synovismicro.com/html/products/stille_surgical_instruments.html
Strengthening Bonds Between the OR and Sterile Processing
A simple, inexpensive addition can help keep each day's schedule running smoothly.
One of the biggest challenges for many high-volume surgery centers is ensuring that patient flow is not impacted by holdups and bottlenecks on the back end. Those problems can have a cascading effect that impacts patients and staff and creates longer days at the facility than everyone would prefer.
Those bottlenecks can not only include last-minute changes to the surgical schedule and unexpected surgeon requests, but also delays in cases that require specialized instrumentation that can throw a wrench into the flow of instruments throughout a facility.
Julie Jackson, a-IPC, CST, MEd, FAST, an infection prevention consultant based in Munith, Mich., proposes a simple fix that could mitigate the instrumentation issue: installing a whiteboard in the hall outside of the ORs. Using the whiteboard, members of the surgical team can alert sterile processing staff about specific instrument needs for upcoming cases that could impact when specific trays or tools are needed.
Consider one example of the potential efficacy of this system: staff can notify sterile processing that the same instruments being used during a 9 a.m. case in one OR need to be prioritized for reprocessing and returned to another OR for a case scheduled to begin at 4 p.m. "That alert lets reprocessing techs plan ahead to have the instruments ready without rushing and cutting corners in the sterilization process," says Ms. Jackson.
In this scenario, a lead sterile processing tech can regularly check the board for updates and then add their own note on the board to inform OR staff that their requests have been acknowledged, update the status of the needed instruments, or inform OR staff that their requests have been completed.
"This method of communication keeps staffs in the ORs and sterile processing on the same page, which improves collaboration between the groups," says Ms. Jackson. All it requires is a quick trip to an office supply store or website.
Is Offsite Instrument Reprocessing Right for Your Facility?
The key is to make sure the financial numbers work while engaging a provider you can trust.
More healthcare providers in the U.S. are expected to opt into third-party instrument care services in the next few years, according to a report from Frost & Sullivan, a research and consulting firm in San Antonio.
Exploring new solutions for instrument reprocessing is an increasingly important exercise for surgery centers and health systems that are seeing a steady uptick in demand for outpatient surgeries. Some facilities that have implemented offsite reprocessing programs say they are seeing wide-ranging benefits, from streamlined instrument care to increased surgical capacity.
The instrument care professionals who run offsite reprocessing centers provide standardized cleaning, sterilization and maintenance/repair services with strict quality control. They pick up soiled instruments, transport them to a large reprocessing facility, clean and sterilize the tools and return repackaged trays that are ready for use in surgery.
Health systems and outpatient surgery centers that invest in outsourcing alternatives enjoy more space to serve patients while streamlining and standardizing their sterilization process. Facilities that want to dedicate more square footage to new ORs in response to increasing case volumes can create more in-house space without needing to physically expand simply by removing their in-house sterile processing area.
That's not all. OrthoIllinois Surgery Center in Rockford, Ill., which has partnered with an offsite reprocessing service, says that the move has also reduced instrument backlogs for total joint replacements. "We had reached capacity in our sterile processing department (SPD) and needed to get creative if we were going to process instrument trays quickly enough to accommodate more cases," says Business Manager Leanne Brennan.
Erlanger Health System, a multi-hospital system in Chattanooga, Tenn., performs tens of thousands of surgeries each year in dozens of ORs spread across several campuses. Recently, it signed a partnership with a third-party offsite reprocessing center that will reprocess and care for its instruments over the next two decades. Adam Royer, BSN, RN, senior director of surgical services, says the shift requires changing the mindsets of staff members who are used to the job being performed in-house.
He says gradually increasing the number of trays that are sent offsite helps to build trust in the process in-house. "Like any other effort to make change happen, it requires constant communication with the stakeholders and taking remediation actions when issues arise," says Mr. Royer.
The setup won't necessarily work for some facilities. Slow or stagnant case volume could keep traditional onsite reprocessing more cost-effective. If your center is exploring the possibility of a shift to a third-party offsite reprocessing service, Mr. Royer says it's vital to identify a company you can trust that is expert in high-quality, on-time tray deliveries.