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Traceability of Surgical Kits and Management of Sterilization Process through BBraun Software instacount ® PLUS CSSD Manager Paolo Turri Säo Paulo SOBECC, 20 jul. 2009
Traceability of Surgical Kits
and Management of Sterilization Process
through BBraun Software instacount®PLUS
CSSD Manager Paolo TurriSäo Paulo SOBECC, 20 jul. 2009
2 Our Hospital: Istituto Clinico Humanitas
Paolo Turri
Emergency Department
7 Operating Theatres
24 Beds Intensive Care
72 Beds Day
Hospital
140 Salt Outpatients
25 Operating Room
21 Ward
747 Beds
IRCCS Gastroenterology
5 Angiography Room
Università degli Studi di Milano Faculty of Medicine and Surgery
University Research Center
10 Box Physiotherapy
SOBECC, 20 July 2009
3
Paolo Turri
Year 2008
Inpatient NHS 42.187
Surgery 28.262
Admission NHS 24.890
Admission D.H. 14.765
Admission E.D. 7.218
Admission Rehab. 2.531
Outpatient 1.061.957
Inpatient Insurance 3.533
Admission Insurance 1.909
Admission D.H. Insurance 1.624
I.F. Articles published
Impact factor 2008 938
Impact factor overall 3.958
Medical 449
Nurses and support staff 936
Customer Service 161
Staff 157
Research Area 89
Other 78
Total 1.870
Students UNIMI 410
Our Hospital in 2008
SOBECC, 20 July 2009
4
In 2008
Ø 1 CSSD
Ø 4 decentralize decontamination area
Ø 23 persons in Staff
Ø Kits products ≅≅≅≅ 79.500
Ø StU products ≅≅≅≅ 65.000
Paolo Turri
Our Sterilization Service
SOBECC, 20 July 2009
5
Traceability
is the recording of all stages and
activities of a process
in order to reconstruct it.
Traceability
Paolo TurriSOBECC, 20 July 2009
6
Paolo TurriSOBECC, 20 July 2009
Tracking the process
7
Traceability helps to Identify
Ø Surgical Kit \ Medical Device Acceptance
Ø Type of Washing
Ø Assembly / Repackaging
Ø Sterilization
Ø Delivery and Distribution
Ø Storage
Ø Final User \ Patient
Tracking the process
Paolo TurriSOBECC, 20 July 2009
8
Ø Traceability of the Process
Ø Safety in the Process
Ø Control of the Process
Ø Process Improvement
Ø Training of the Staff
Ø Cost Control
Paolo Turri
Needs
SOBECC, 20 July 2009
9
Ø 1996 to 2006 Manual Traceability
Ø 2006 Installing a Software for
Traceability, instacont®PLUS of BBraun
Ø In CSSD One Dedicate Nurse was
Necessary to Developing the Project
Ø 17 Workstation Installed
Paolo TurriSOBECC, 20 July 2009
Traceability in ICH
10
We chose a system of traceability in
order to:
Ø Trace the Process
Ø Govern the Process
Ø Managing the Surgical Instruments Asset
Software of traceability
Paolo TurriSOBECC, 20 July 2009
11 Tracking the process
Paolo Turri
Decontamination Area
Washer\Disinfectors
Repackaging
Area
Steam Sterilize
CSSD Stock
Sterile Area
Delivery
Area
To Operating Theatre
From Operating
Theatre
To Ward
Workstation
Loading
Area
SOBECC, 20 July 2009
12
Ø Staff is Identified
Ø Kits are Identified whit Bar-Code
Ø Surgical Instruments are Identified whit Data-Matrix
Ø Equipments are Identified whit Bar-Code
Ø All Activities are Recorded by System
Paolo Turri
Tracking the process
SOBECC, 20 July 2009
13
Paolo TurriSOBECC, 20 July 2009
Tracking the process
14
Ø Staff is Supported by the Software
Ø Repackaging-List are Updated in Real Time
Ø Correct Destination of Kits
Ø Proper Allocation Costs
Ø Vision Workflow
Ø Analysis of Use Equipment
Govern the process
Paolo TurriSOBECC, 20 July 2009
15 Decontamination Area
Paolo TurriSOBECC, 20 July 2009
16 Decontamination Area
Paolo TurriSOBECC, 20 July 2009
17 Repackaging Area, Before
Paolo TurriSOBECC, 20 July 2009
18 Repackaging Area, After
Paolo TurriSOBECC, 20 July 2009
19 Repacking-List, Before
Paolo Turri
SET ILIZAROVALVEARE A1 B1 C1
DESCRIZIONE MISURA CODICE n° pezzi NOTE
n° fori
GIUNTO PER CERNIERA F /standard 1 101700 20 imbustare
GIUNTO PER CERNIERA M /standard 1 101600 20 20M + 20F
GIUNTO PER CERNIERA F /prof basso 1 101702 20 imbustare
GIUNTO PER CERNIERA M /prof basso 1 101602 20 20M + 20F
BANDIERINA A FILETTO FEMMINA 2 101500 10 imbustare
BANDIERINA A FILETTO MASCHIO 2 101400 10 10 M+10F
BANDIERINA A FILETTO FEMMINA 3 101501 10 imbustare
BANDIERINA A FILETTO MASCHIO 3 101401 10 10 M+10F
BANDIERINA A FILETTO FEMMINA 4 101502 10 imbustare
BANDIERINA A FILETTO MASCHIO 4 101402 10 10 M+10F
STRUMENTI
CHIAVE ANGOLATA CH10 103000 1
CHIAVE RETTA CH10 102900 2
CHIAVE PER DADI CH10/CH13 202002 2
SOBECC, 20 July 2009
20 Repacking-List, After
Paolo TurriSOBECC, 20 July 2009
21 Sterilizer Loading Area
Paolo TurriSOBECC, 20 July 2009
22 Sterilizer Delivery Area
Paolo TurriSOBECC, 20 July 2009
23 Management the Process
Paolo TurriSOBECC, 20 July 2009
24
Ø Accurate Stock Kits Data-Base
Ø Accurate Kit-Lists Data-Base
Ø Analysis of Use Kit
Ø Costs Allocated to Operating Units
Ø Accurate Repairs / Maintenance Data-Base
Ø Purchases Data-Base
Ø Errors in the Process Data-Base
Managing the Surgical Instruments Asset
Paolo TurriSOBECC, 20 July 2009
25
Paolo TurriSOBECC, 20 July 2009
Managing the Surgical Instruments Asset
26
Paolo TurriSOBECC, 20 July 2009
Managing the Surgical Instruments Asset
27
Paolo TurriSOBECC, 20 July 2009
Managing the Surgical Instruments Asset
28
Paolo TurriSOBECC, 20 July 2009
Managing the Surgical Instruments Asset
29
Ø Standardization of Processes,through unification of procedures and
training of the staff
Ø Increase Productivity by 20%, same equipment and human resources
Results after 3 years
Our Results
Paolo TurriSOBECC, 20 July 2009
30
Ø Updated Stock Kits Data-Base
Ø Updated Kit-Lists Data-Base
Ø Updated Repairs / Maintenance Data-Base
Ø Kits Statistic Production
Ø Report of Errors in the Process
Our Results
Paolo Turri
Results after 3 years
SOBECC, 20 July 2009
31
Ø Investment Management
Ø Kit Optimization
Ø Stock Kit optimization
Ø Analysis of Use Equipment
Our Results
Paolo Turri
Results after 3 years
SOBECC, 20 July 2009
32 Analysis of Use Equipments
Paolo TurriSOBECC, 20 July 2009
STEAM ST. SITE St.U. RUN 134°C 121°C 134°CTOTAL
CYCLESSt.U.
St.U.
AVERAGESt.U./DIE
AVERAGE
CYCLES
RUBINO CSSD 8 23 hour 845 189 316 1350 10800 40,00 40 5
SMERALDO CSSD 8 23 hour 1017 296 231 1544 12352 45,75 48 6
TOPAZIO CSSD 8 23 hour 943 228 270 1441 11528 42,70 48 6
EOLO BOD 1 14 hour 2083 23 2106 2106 8,78 9 9
HERMES BOD 1 14 hour 1788 13 1801 1801 7,50 8 8
COLOMBO BOE 4 14 hour 841 42 883 3532 14,72 16 4
S. MARIA BOE 4 14 hour 734 35 769 3076 12,82 16 4
PINTA BOE 4 14 hour 556 20 576 2304 9,60 16 4
NINA BOE 2 14 hour 532 25 557 1114 4,64 6 3
LUNA BOF 4 24 hour 1749 230 1979 7916 32,98 36 9
ROSA BOC 1 14 hour 1800 1800 1800 7,50 7 7
MINNIE BOA 1 24 hour 1023 1023 1023 3,79 4 4
TOPOLINO BOA 1 24 hour 773 773 773 2,86 3 3
47 14684 1101 16602 60125 233,63 257 72
STERRAD SHORT LONG
ZAFFIRO BOE 1 14 1217 23 1240 CYCLES
QUARZO CSSD 1 23 2908 12 2920 4160 St.U. TOT. 64285
YEAR 2008
33 Analysis of Use Surgical Kit
Paolo Turri
Kit’s name StockMax. number of
daily reprocessesKit to Add Kit Excess
Medi interventi 13 7 6Artroscopia di
Spalla 8 13 5
Ernia discale 6 4 2
Carotide 3 5 2
Mano 5 7 2
SOBECC, 20 July 2009
34
Kit Optimization:
Equipping Kit whit surgical instruments
actually needed, making efficiency in
type and number of them,
in order to meet surgical specific tool.
Kit Optimization
Paolo TurriSOBECC, 20 July 2009
35 Surgical Kit Optimization
Paolo Turri
Kit’s Name StockNumber of
Items, Before
Number of
Items, After
Total
Deviation
Grandi Interventi 7 138 114 -168
Medi Interventi 13 90 70 -260
Piccoli Interventi 20 60 45 -300
Total 3336 2608 -728
SOBECC, 20 July 2009
36 Surgical Kit Optimization
Paolo Turri
Kit’s Name Stock Initial Weight Final WeightTotal Weight
removed
Grandi Interventi 7 14.20 Kg 12.96 Kg -8.8 Kg
Medi Interventi 13 9.85 Kg 8.58 Kg -13 Kg
Piccoli Interventi 20 6.00 Kg 5.50 Kg -10 Kg
Total 347.5 Kg 315.7 Kg -31.8 Kg
SOBECC, 20 July 2009
37 Govern the Process, the Future in ICH
Paolo Turri
Operating Room Operating Room
Stock
Sterile
Stock
Sterile
From CSSD
To CSSD
Workstation
SOBECC, 20 July 2009
38
It’s not only introducing software
that enhances the activity in a
Sterilization Service.
The human element, the training
and managerial approach to the
processes are winning.
Paolo TurriSOBECC, 20 July 2009
39
Paolo TurriSOBECC, 20 July 2009
Moon 20 July 1969
We manage our sterilization errors: do you?
Paolo Turri, Chiara Oggioni
10th World Congress of Sterilization
Crete-Greece
7-10 october 2009
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