Sterilized Containment Systems

Instrument Sets
Standardization and tracking are crucial to instrument management

By R. Michael Appleby

"Instrument set" is a broad term and could be used to describe asingle surgical instrument needed for a simple task, a disposable instrument setused for a specific procedure in the ER or on the floor, or a specialty set ofinstruments used in the OR, ranging from a few handheld surgical instruments toover a hundred different patterns.

Surgical instruments are organized into sets to meet specific requirementsdetermined by the intended use. A single splinter forceps could be classified asan instrument set when used in the office or ER to remove a splinter. Adisposable instrument set might prove to be cost effective and eliminate lost orstolen instruments in an ER suture tray. The OR, outpatient suites, or labor anddelivery rooms require instrument sets based on the surgical procedures to beperformed therein.

Each set should contain only those instruments required to perform thespecific task for which the set was created. Instrument sets may also containbasins, medicine cups, four-by-fours, and other items that are needed each timethe set is used and that can be sterilized together.

Every effort should be taken to standardize specific instrument sets. Insteadof having "Dr. Smith's Minor Set" and "Dr. Jones' MinorSet," there should be one Minor Set. If Dr Smith or Dr Jones asks foradditional items, it is more cost effective to single-wrap these items and pickthem for the specific doctor's case. This eliminates initial purchases,processing time, and charges as well as repair costs. Specialty charge nursesshould work with the physicians using the trays to get agreement forstandardization.

Once the instrument set contents are determined, a "pick list"should be created listing a vendor catalog number, item description, quantity,and unit of measure. In addition, there should be spaces for processing to fillin quantities that were processed for the person opening the tray to fill inquantities found in the set, for the person completing the procedure to fill inquantities for items being returned to processing, and for processing to fill inquantities for instruments returned. Each person should initial the quantitiesso that "missing" instruments can be traced to a specific person andlocated. The pick list should stay with the instrument set throughout itstravels from processing to department of use to processing department. The useof a pick list with the entries for each time the instrument set is handled isthe only way to eliminate lost instruments.

One person should have authority to change the pick list contents onceeveryone involved has agreed to the change. This will eliminate confusion,duplication, and the unnecessary expense of having too much or not enough in aninstrument set. Before creating a "new" instrument set, every effortshould be made to determine if an existing one will accomplish the goals forwhich the set is being created. A new instrument set should be created only whenan existing set contains too few or too many instruments.

Another challenge is having the correct number of instrument sets for aspecific time period--generally a day's procedures. It is important to haveenough instrument sets to cover your daily needs without placing undue stress onthe processing department to turn sets over or having sets stay on the shelf.Use the pick lists and work with your surgical instrument sales representativeto determine correct levels based on daily demand to direct assets from anoverused set to an underused set.

Surgical instrument sets are one of the largest assets in the operatingarena. Generally, there are too many non-standardized sets in use. Workingtogether with your charge nurses, surgeons and instrument sales representativesto manage these assets can lead to less sets, more standardization, and loweracquisition and repair costs associated with your surgical instruments.

R. Michael Appleby is an Instrument Asset Management Consultant forAllegiance Healthcare Corporation, V. Mueller in McGaw Park, Ill. He has beenassociated with V. Mueller since 1969.

Sterilized Containment Systems

CaseMedical® offers customization services along with its universal line ofSteriTite® sealed containers and MediTray® products. Case's team of productspecialists visit facilities to help staff find solutions to better sterilize,store and protect surgical devices and instruments. According to Case, customershave saved thousands of dollars in repair and replacement expenses throughbetter organization and use of protective inserts.

For more information contact Case Medical, Inc.
(201) 313-1999
www.casemed.com 

Sterilization in a Hurry

Keepinstruments sterile with the STATIM system by SciCan. According to the company,STATIM's removable sterilization chamber acts as a sterile transportation systembetween autoclave and patient. Cassette remains closed until circulator opens itat the operative site. Fast steam injection system allows autoclave of even themost delicate instruments without fear of damage. A sterilization cycle of justover 9 minutes allows staff to sterilize instruments between or duringprocedures.

For more information contact
SciCan, Inc.
(800) 572-1211
www.scican.com

Instrument ID tags

Resinbonded tags, shaped and drilled for use in tray identification procedures, helpstaff maintain organization. Tags may be used with bar code labels orhand-written notes. All instruments remain with the sterilization basketthroughout collection, decontamination and sterilization processes. Tags areX-ray detectable and come attached with stainless steel rings or special nylonties.

For more information contact
HealthMark Industries (800) 521-6224
www.hmark.com

Safety Scalpel

Designedby a heart surgeon and safety engineer, DeRoyal's Retractable Safety Scalpelfeatures a retractable, stainless steel blade activated with one hand duringsurgery, and recessed for use among personnel. An audible click identifies bladeposition, while "biohazard red" color is easily seen on safety zone insterile field. Slip-resistant grips and slim-comfort styling allow surgeons touse any cutting position desired, according to the company. Meets OSHA standardsas defined in the Nov. 1999 directive advocating the use of sharps devicesengineered to reduce the risk of exposure.

For more information contact De Royal Industries
(800) 251-9864
www.deroyal.com

Genesis Containers Program

Genesis Sterilization Container Systems are backed by a lifetime warrantyfor materials and workmanship, and are designed to provide excellent sterilitymaintenance and instrument protection, the company says. Genesis Maintenanceand Repair Program offers authorized repair service for Genesis containers.Repairs can be made at the company's facilities or on your premises throughOn-Site® service.

For more information contact
Allegiance Healthcare Corp.
(800) 227-3220
www.cardinal.com/allegiance

See-Through Storage for Endoscopes

Custom-designed for Karl Storz endoscope and instrument sets, each trayfeatures silicone holding bars to secure components firmly in place. See-throughlids allow easy identification without breaking the sterile seal. According tothe company, each tray is made from rugged, advanced plastic polymers to protectendoscopes during transport, storage and steam or ethylene oxide sterilization.

For more information contact
Karl Storz Endoscopy America, Inc. (800) 421-0837
www.karlstorz.com

Protect and sterilize delicate instruments with PST trays

PST trays are manufactured with a "pebble-like" surface, whichraises the silicone mat from the tray surface, preventing adhesion of the mat tothe surface of the tray and ensuring for proper penetration of steam between matand tray. PST instrument trays are manufactured with an advanced medical gradeplastic that is compatible with most sterilization protocols. According thecompany, PST trays protect expensive surgical instruments during sterilization,storage and transportation and help to avoid costly repairs.

For more information contact Plastic Sterilizing Tray Company
(800) PST-TRAY
www.pst-corp.com

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