Understanding the Elements of Reprocessing Surgical Instrumentation for Clinically Safer and Financially Sound Outcomes

Understanding the elements of reprocessing surgical instruments is pivotal to the overall success of surgical operations. The components are often overlooked and not considered and as a result sometimes harms our patients or causes undue excess expenses. This article will capture some key considerations in the instrument processing function.

Instrumentation used during surgical procedures requires special management to help prevent the spread of infection and potential costly and unnecessary additional acquisitions. Appling appropriate purchasing techniques to ensure adequate operational funding for needed equipment through the fiscal budget year is important. Proper handling pre- and post-operation usually lengthens the usable life of devices and helps to prevent the loss of having the “right item at the right time” for care providers. Precious time in reprocessing is also often gained when basic principles are applied once an instrument is used. All of these elements can be used to augment and improve the total reprocessing program for various types of facilities, regardless of the size or nature of the institute and all help to keep all customers and key stakeholders content.

A deeper look into reprocessing instrumentation uncovers various root elements that can hinder the process of making an item suitable for reuse. Simple changes in the methods and techniques used to reprocess can greatly change the outcome from marginally acceptable to appropriate on many levels. In order to achieve this, an in depth understanding of the inevitable variables is needed to be able to create a structure to work within. Some of these considerations include the following:

• Limited quantity of frequently used items

• Special processing requirements, such as unusual sterilization parameters or agents

• Design limitations

• Unusual materials

• Unforeseen add-on cases

• Changes in the order of previously scheduled cases in relation to the pre-coordinated instrument/equipment processing orchestration/timing

• Physician requests conflict with availability

Having a less-than-robust inventory of critically needed reusable devices can greatly hinder the process of providing surgical intervention in a timely manner, especially if there is a knowledge deficit or lack of communication to and from the direct surgical team to any and all other supportive staff members concern this issue. However, it is not always possible or wise to have such an abundance of instrumentation as general overall volumes often change and as such, the type specialties of cases and their related volumes also vary.

Quantity of instrumentation alone is not the most limiting of factors. In fact, with a properly designed program aligning equipment needs with equipment availability and cross-referencing/conflict resolution and the seemingly inevitable situations can be avoided, often without the need of excessive instrumentation. There is a push from both the clinical and materials side to take hold of instrumentation processing and both have good arguments. However, partnering with materials management and other supply chain imperatives can help to put instrumentation back into the hands of individuals geared towards logistics as long as the clinical mind and skill set is available from this reporting function.

Ensuring that next-year budgets are crafted and submitted based from analytical data and general information is critical. Making reasonable assumptions, based on research, past volume, reasonable forecasts and inflation can greatly and positively affect how well your hospitals resources are used for not only the immediate future, but also for the longer term. This should include, but certainly should not be limited to the following:

• A reliable expectation of what the additional future workload will be is an important factor.

• A reasonable assumption of what the surgical specialties percentage growth should look like is imperative.

• Review of current research on the latest and most likely tools/methods of operations from a clinical and financial approach is a standard.

Others considerations to assess before purchasing new instruments or equipment are the processing requirements of a particular device or instrument and its potential future relevancy. Processing limitations can slow the availability of an item. However, it can usually be prevented by conducting a comprehensive analysis of any item being considered for purchase since imperative elements are needed to be discovered before final selection occur. In addition, some tracks of healthcare evolve more quickly then others and not all new technology becomes or remains a viable and on going option. Some key questions that should be ascertained may include the following:

• What is the method of decontamination?

• What is the method of sterilization?

• What are the limitations of the device for reprocessing?

• Is there a limit on the reprocessing times?

• Can the item be quickly turned around in emergency situations?

• What are the repair requirements and potential costs associated with the repairs?

• What is the complexity factor; will this be a difficult concept to teach and train?

• What has its track record been at other facilities?

• Is it considered “new technology”? If so, how likely is its survivability in the market?

Failure to bear these in mind may result in future purchases to offset processing needs deficits. Keeping all relevant members included in purchasing decisions often prevents misguided acquisitions. This includes keeping the requesting physician in the planning/discussion loop. For example, physicians often have a limited idea of the steps and requirements needed to reprocess goods for reuse for their surgical cases. Not having this solid knowledge base can create conflicts at times. Incorporating a team approach will reduce the need to react and respond to “emergencies” by preplanning and using a “broader lens” to review the full scope of “instrumentation management.” Usually each party knows its respective component very well. It is only when each piece understands the other that the whole picture can been seen and have better or more appropriate decisions made that ultimately benefit the patients served.

In addition, without clear and concise technical information, improper processing may occur. This greatly increases the potential for instrumentation and equipment becoming both a reservoir and vehicle for bioburden transmitting to subsequent patients. There are various methods and applications for sterilizing, all of which vary greatly in the mode of organism death. A slight modification from the original manufacturers’ guidelines jeopardizes the anticipated successful outcome, true sterilization.

Having a strong relationship between the operating room and the sterile processing department is one of the most important factors in whether or not instrumentation is a strong and well-run processing function in the hospital setting. Both departments have dependencies on the other and both have elements that cannot be replicated properly or fully by the other. Often, each unit usually works so independently that they can inadvertently forget that both are just as important of a part of the whole surgical system as the other. In addition, materials management cannot be underscored enough within this process. All three areas greatly contribute to the success of the organization and the wellbeing of the patients to which the respective facility delivers care. Materials management can be the bridge that helps to highlight some of the buying considerations while consulting both SPD and the OR. The materials department often acts as a check and balance for financial terms. It is imperative to have all relative information gathered and assessed to be able to make the most appropriate and well-informed decision and this sometimes needs to include a unit that does not serve any technical or clinical role.

All of these components and more help to ensure that the right items are purchased, handled and prepared in a manner to better ensure safe goods are used on patients rendering service and care from our facilities. We have an obligation to those we serve to examine all matters related to or that has the potential of impeding good care. This certainly includes proper equipment and instrumentation handling and management.

Michele DeMeo is the sterile processing manager at Memorial Hospital in York, Pa. She has written several articles for industry trade journals. She is a voting member for technical working committees for AAMI as an independent expert in sterile processing. In addition, she is the clinical consultant for General Hospital Supply Corporation. DeMeo has 18 years of experience in the management of sterile processing, supply distribution, purchasing and materials handling.