Infection Control Today - 03/2003: Success Story

Newborn Security Monitors Lead to the Adoption of a New SterilizationTechnology at The Woman's Hospital of Texas

By Joyce Dickerson

Infant abduction from a hospital nursery is an infrequent yetdevastating event to all involved. Increased media attention about childabductions and a growing awareness about the need to protect newborns havespurred healthcare facilities around the country to take extra measures toensure the safety of infants and their families. At The Woman's Hospital ofTexas, a Houston-based medical facility devoted exclusively to women'shealthcare, the adoption and deployment of sophisticated, miniature securitytransponders was a key step in guaranteeing protection for the 8,000-plus babiesborn at the facility each year.

The innovative safety devices are attached to each infant upon delivery andare designed to prevent unauthorized removal of babies from the facility bysignaling an alarm if moved beyond established boundaries. While the deviceswere easily and successfully integrated into the nursery's daily clinicalpractice, their sophisticated electronics and specialized reprocessingrequirements created a separate, costly problem.

Compounding Limitations of Current Sterilization Practices

The sterile processing department (SPD) at The Woman's Hospital of Texashandles the instrument processing needs of the 275-bed facility, which includes30 ante-partum, 30 labor and delivery and 98 neonatal intensive care unit (NICU)beds. The department also serves as a backup for the hospital's eight satelliteclinics. For more than 26 years, the department used ethylene oxide (EtO), aswell as steam sterilization to process its medical devices and surgicalinstruments. However, the department identified several limitations with thesystems.

For example, while EtO was compatible with many of the hospital's heat- andmoisture-sensitive instruments, its 16-hour cycle time negatively affected theavailability of sterilized devices and occasionally resulted in delayedsurgeries. Furthermore, because EtO is a carcinogen, costly monitoring deviceswere required to ensure employee and patient safety. Despite concerns about longcycle times and the safety issues associated with EtO, the department had beenunable to justify the cost of converting to a safer system.

These problems were exacerbated with the adoption of the infant transponders,which require sterilization after each use. Manufacturer guidelines for thesterilization of the delicate infant safety devices warned against the use ofEtO or steam sterilization, and endorsed only gas plasma sterilization. Thedepartment, not equipped to sterilize the devices, was forced to send monitorsto the manufacturer for reprocessing. Outsourcing was expensive--$11 for eachmonitor--and sterile monitors often were not returned for two weeks, requiringthe department to maintain a large inventory of the expensive devices. Inaddition, the logistics involved in packaging and shipping the devices to themanufacturer's New Jersey facility and monitoring their return placed an addedburden on department staff.

These factors also greatly added to operating expenditures, forcing thedepartment to seek a safe, fast and cost-effective sterilization technology thatcould be used for the security devices and positively contribute to overallinstrument processing practices.

A New Sterilization Alternative

In an effort to alleviate the expense and inconvenience of outsourcing infantsafety devices, the SPD began researching alternative sterilization techniques.Department staff learned that the manufacturer of the security devices utilizeda low-temperature hydrogen peroxide gas plasma sterilization system [STERRAD100S Sterilization System from Advanced Sterilization Products (ASP)] toreprocess the infant monitors. The manufacturer had completed cycle andvalidation procedures for the safety devices using the hydrogen peroxide gasplasma system. Upon review, department personnel determined they couldcost-effectively sterilize the monitors in-house using the same system, and theybegan the process of collecting supporting data to present to hospitaladministrators in order to justify the capital expenditure.

To ensure that the hydrogen peroxide gas plasma system would meet hospitalneeds and decrease costs, the SPD, along with the infection control, security,surgery and nursery departments, outlined several criteria, determining that thenew sterilization system must be safe, cost-effective, environmentally friendly,fast and compatible with a wide range of instruments beyond the infant safetymonitors

Confident that the hydrogen peroxide gas plasma system met these criteria,the SPD approached hospital administrators about purchasing the new system. InMay 2002, the department received approval and acquired a STERRAD 100S System.

Immediate Benefits

Once installed, the hydrogen peroxide gas plasma sterilization system made animmediate, positive impact on the department and patient care. Because of thesystem's fast, 55-minute turnaround time and terminal sterilization capability,concerns about a shortage of available sterile infant safety monitors werealleviated. Furthermore, the department no longer had the burden of packagingthe devices for shipment to the manufacturer for sterilization and trackingtheir return.

Most importantly, department costs were significantly reduced. By eliminatingexpensive outsourcing for the devices, the department was able to project anannual saving in excess of $118,000, more than covering the cost of thesterilization system in just the first year.

In addition, the hydrogen peroxide gas plasma system's high level ofmaterials compatibility enabled the department to sterilize most of thehospital's heat- and moisture-sensitive instruments previously processed usingEtO, thus eliminating EtO use at the facility. The system's fast cycle time alsohas improved instrument processing and reduced surgical delays caused by a lackof sterile instruments. The removal of EtO also has eliminated safety concernssurrounding its use and the need for mandatory employee monitoring, furthercontributing to the department's cost savings.

Overall, the department's transition to the STERRAD System was seamless andthe facility experienced no downtime. Integration was greatly facilitated by thesystem's minimal installation requirements and the fact that no specialequipment, such as heat boosters, plumbing, vents or drains is needed.

Hospitals are continuously challenged to provide exceptional patient carewhile facing increasingly tight budgets. For many hospital administrators, theconstant pressure to reduce costs limits the ability to integrate newtechnology, such as sophisticated security systems, that can enhance patientcare and safety. The adoption of the STERRAD Sterilization System has allowedThe Woman's Hospital of Texas to dramatically reduce costs while providing thebest patient care. The hospital is proud of its pioneering roles in both infantsafety and instrument processing and hopes that telling its story will helpother facilities faced with similar challenges.

Joyce Dickerson is sterile processing manager at The Woman's Hospital ofTexas.