Infection Control Today - 05/2004: Effective Management

Effective Management of Borrowed Instrumentation

By RichardP. Blasko, MBA, CSPDT, CRCST

Given the lofty expenditure onsurgical supplies and declining reimbursement, many facilities that specializein total joint replacements have had to resort to consignment of instrumentationon a case-by-case basis from the manufacturers of the implants. Surgeon preferences vacillate; it is not judicious to acquireall the various systems available in your sterile inventory.

Sterile processing managers are left with the prodigious taskof managing a myriad of trays from multiple vendors flowing in and out almostdaily. Lost or misplaced individual instruments or complete trays can prove acostly mistake. In addition, you must assure your customers that a consistentlyhigh standard of care is afforded to these trays to prevent cross-contamination.

To effectively manage this situation, you need to have anexplicit yet simplistic policy to track all facets of a loaned item from receiptto return. Listed below is an illustration of a procedure that I havefound successful in controlling loaned instrumentation.

Preparation of Policies and Procedures

A formal policy must be constructed that delineates eachspecific step involved and to whom the responsibility will fall to execute thatprocedure. A committee should be formed that embodies representativesfrom management, staff and the operating room. Input from all three perspectiveswill prove fruitful in assuring compliance and ultimate success.

Once a policy has been affirmed, the next step is to in-servicenot only your staff, but the representatives of the vendors that introduce theinstruments to your facility. We supplied pre-printed index cards to eachrepresentative listing all management pager numbers and an abridged descriptionof the policy requirements. Involvement of the vendors is imperative to theefficacy of your policy.

Receipt of Instruments

When instruments are brought to the department, vendors arerequired to contact one of the management staff listed on their index card. Ifno members of management are present, then the responsibility to check in theinstruments shifts to the most senior technician. Before the instruments areaccepted, the vendor is obligated to furnish the following information:

• Date of surgery

• Time of surgery

• Name of physician

• Number of trays

• Vendor name

• Color of plastic chip

A colored plastic chip is deposited in each tray by the vendordesignating that tray for a specific surgery. The aforementioned information isalso transcribed on a large dry-erase board. The trays are sent to thedecontamination area for washing and disinfection. Do not allow trays to bypassthe decontamination process or you will compromise the sterility of theinstruments, as well as the integrity of your department.

Assembly and Sterilization of Instruments

After decontamination, the trays are ready to be assembled forsterilization. The technician wrapping the trays will remove the color chipand transfer the necessary information from the dry-erase board to thesterilization tape. In addition, the trays are numbered 1 of total, 2 of total,etc. This guarantees that the required trays will remain intact for the surgeryfor which they were intended. A red sticker labeled LOANER is affixed to the outside tape to further alert staff of thetrays status. Finally, the sterile trays are transported to the sterilestorage area and remain on the transport rack until requested by surgery.

Return of Instrumentation

After use, the trays are decontaminated and placed on aholding rack awaiting repossession by the vendor. When the vendor returns, theyare required to examine the instruments with management or a senior technician. Any discrepancies must be noted at this point by the vendor.Once the instrumentation leaves your department, the process is finalized. Thecorresponding information may be removed from the dry-erase board.

By tracking loaned instrumentation by use of colored chips anda dry-erase board we have realized a tangible reduction in incidents concerningborrowed equipment. Our department has managed up to 40 separate instrumenttrays designated for eight different surgeries in one day. Without a concrete, effective policy in place, coordinatingsuch a task would be difficult, at best.

Richard P. Blasko, MBA, CSPDT, CRCST, is supervisor ofsurgical processing and support services at Akron General Medical Center inAkron, Ohio. In addition, he is the instructor of the sterile processing/central service course at the University of Akron.