Protecting Your Instruments:
“Understanding theImportance of ProtectingYour Most Valuable Assets: Your Instrument Inventory”
PRESENTED BY:
HEALTHMARK INDUSTRIES
CHERON ROJO (SPD Educational Coordinator for Healthmark)
Cheron Rojo is a CRCST (Certified Registered Central Service Technician), CIS (Certified Instrument Specialist), (CER) Certified Endoscope Reprocesser), (CFER) Certified Flexible Endoscope Reprocesser, and a CHL (Certified Healthcare Leader). He served on the PDRC (Professional Development Resource Committee) for IAHCSMM, as well as the Education Director for the CCSA (California Central Service Association).
Mr. Rojo has 27 years in the Sterile Processing arena as a Sterile Processing Technician, SPD Educator, an Instrument Coordinator, and a Surgical Technologist in the Surgical realm.AA, CRCST, CIS, CER,
CFER, CHL
Disclosure
I am an employee of Healthmark Industries Fraser, Michigan USA
I am involved with the manufacture and distribution of medical
products to healthcare facilities and healthcare professionals
All opinions are those of the presenter
This presentation reflects the techniques, approaches, and opinions of
the individual presenter.
This sponsored presentation is not intended to be used as a training
guide or promotion.
Before using any medical device, review all relevant package inserts
with particular attention to the indications, contraindications, warnings
and precautions, and steps for the use of the device(s).
Healthmark Policy & Philosophy
Healthmark’s Policy is to provide our customers and the healthcarecommunity with the highest quality, state of the art medical products and support services in a timely and cost effective manner.
This goal is supported by a staff committed to individual accountability, professionalism, mutual respect, collaboration, and service excellence. This presentation is part of that commitment, educating our customers.
Healthmark's Philosophy
More than just running a test, it is a quality improvement process
Clinically relevant, evidence-based products
Support of products both clinically and educationally
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Survey Question 1
Who is attending today?
SPD Professionals
OR Professionals
Infection Prevention Professionals
Endoscopy Professionals
Other Professionals
Objectives
To briefly explain the history of instrument design and their function
To define what the majority of instrumentation are made of
To explain the role of inspection in the protection of instrumentation
To explain the importance of why you should protect them and how
Understanding these points will help you
reduce your repairs, protect your
instrumentation, and make them last longer!
History of
Instruments
1950’s: General dissection, stainless steel, long life, instruments made primarily of heat stable materials
1959: First flexible endoscope
1960’s - 70’s: Metal, increasing complexity (new sterilization cycles), space age material, proliferation of heat sensitive items, increasing complexity and delicacy
Late 1970’s: “Take-aparts” started to enter the market
1980’s - Today: Stainless steel that ranges from simple to complex, various metals, titanium, polymers, and combinations of materials, highly complex designs, lots of lumens, delicate and expensive
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Why Some of These Changes?
Mostly Changes in Surgical Technique
Open Surgery -Laparoscopic
Gynecology -Laparoscopic
General Surgery-Laparoscopic Chole
Orthopedic Surgery -Arthroscopy
Cardiac Surgery - C.A.B.G.
All Specialties - Robotics
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These Changes BroughtAbout Concerns:
Design challenges
Reprocessing is not the top priority in instrument design, cleaning difficulty, no validated process
Processing instructions are vague, incomplete, absent, compatibility with the sterilization process, long narrow lumens, multiple parts tiny serrations
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Concerns Continued
Costs – More complex and delicate, leads
to escalating financial impact
Unintended Consequence- fewer trays,
increased use, and increased repairs
Time constraints - quick turn around time
needed
Lack of respect for care & handling
process
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Stainless Steel (most used type of metal in instrument trays
S.S. is the most common
Simplest form is made up of carbon and iron
The higher the carbon, the harder the steel (can be made many ways)
Other elements are added to make the instruments stronger when needed
S.S. instruments are preferred, because they can withstand the rigorous use, as well as the exposure to processing (steam sterilization)
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Passivation
A chemical process that removes all iron particles leaving a corrosion-resistant surface by forming a thin transparent oxide film.
Passivation subjects the instrument to solution of diluted acid and oxidizing salts.
Polishing
Protecting the passivation layer and promoting its continued buildup is an important objective of instrument care. If the oxidized layer is destroyed or damaged, the instrument will have a greater tendency to rust.
Care and
Handling
Instrumentation should be
carefully handled and
removed from instrument
trays and processing baskets
They should never be
dumped onto work tables
How do you Protect Your Investments?
Inspection
Tray Liners
Tip Protectors
Specialty Trays
Team Training
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Survey Question 2
How many of you have some sort of adequate magnification
device for external surfaces at your workstation to inspect
instrumentation correctly?
Standards and Guidelines
AORN: Tools such as video borescopes of an appropriate dimension (length and diameter) may be used to visually inspect the internal channels
Internal channels of endoscopes may be inspected using a borescope. Borescopes penetrate the lumen and allow for improved visual inspection.*
* Guideline for processing flexible endoscopes. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2018:799-882.
AAMI ST91: tools such as video borescopes of an appropriate dimension (length and diameter) may be used to visually inspect the internal channels of some medical devices*
* ANSI/AAMI ST91:2015 Flexible and Semi-rigid Endoscope Processing in Health Care Facilities. Arlington, VA: Association for the Advancement of Medical Instrumentation; 2015
AAMI ST 79 : Inspection using enhanced visualization tools such as lighted magnification and video borescopes might identify residues not observable by the unaided eye.*
* © 2017 Association for the Advancement of Medical Instrumentation ■ ANSI/AAMI ST79:2017
Standards and Guidelines
SGNA: Inspection may involve the use of a magnifying glass to inspect for gross soil.
Visual inspection alone is insufficient to determine cleaning adequacy in narrow and internal channels of a scope and cannot detect microorganisms or bioburden
Use magnification and adequate lighting to help assist in visual inspection
Time out for visual inspection
CDC: Consideration should be given to use of a magnifying glass (e.g., 10x) to improve detection of residual debris around the elevator mechanism
APIC: The IP will evaluate human factors, including ensuring that the cleaning area is set up with a bright light and magnification so all sections of the scope being cleaned can be well visualized.
Survey Question 3
How many of you have a flexible inspection scope
(borescope) to inspect internal lumen devices i.e.
shavers, G.I. Endoscopes?
Inspection of Instrumentation:The Basic Points
Before assembly, inspect
instruments for pits, cracks,
bent tips, misalignment,
corrosion, etc.
Inspection of Instrumentation:The Basic Points
Make sure that
moving parts work
freely and that
instruments are in
perfect operating
condition
Inspection of Instrumentation:The Basic Points
Depending on department procedure tag and remove rejected instruments from trays
Follow the OEM (Original Equipment Manufacturer) of the instruments IFU (Instruction For Use) for the proper inspection process
Sharpness
Alignment
Other
Different OEM have different requirements for inspection of their instrumentation
Survey Question 4
Do you feel at your facility that you have a solid process for the
checking of instrumentation that need repair?
Inspection of
Instrumentation
Continued Assemble instruments into trays, in
accordance with departmental procedures
Load instrumentation in a way to dispense the weight evenly in the tray
Total weight of the instrument set should not exceed 25 pounds or a weight documented by the manufacturer of the sterilizer or container system
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Wrap Like-Metals Together
Wrap "like-metals" such
as copper/brass and
stainless steel/chrome
plated instruments
together, where
practical, using tray liners
or towels to separate
where necessary
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Keep InstrumentsOrganized and Open
Place ring-handled
instruments on stringers, pins,
or racks to keep them open
Point clamps with curved
jaws in the same direction to
protect tips
Position cupped or concave
instruments to avoid water
collection
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Wrap Small, Delicate
Instruments Separately
Wrap the smallest, delicate, and sharp cutting instrumentation in woven or nonwoven towels, or other specially designed pouches
Use a medical grade silicon ties to bundle instruments together
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NOTE: (rubber bands should not be used to hold instruments together)
Protect Delicate Tips
Protect the tips that
are sharps with
protectors that can
be sterilized.
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Survey Question 5
How many of you feel you have enough of a selection of instrument
protection products at your facility?
Choose the Correct Type of Instrument Tray
A 2014 report showed the larger the
instrument tray, the greater the
incidence of instrument damage.
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* Emily Walker Stockert, MBA, Alexander Langerman, MD, FACS, 2014Assessing the Magnitude and Costs ofIntraoperative Inefficiencies Attributable to Surgical Instrument Trays
Choose the Correct Type of Instrument Tray 2014 Report
Trays designed to protect delicate instruments provide real measurable results, according to the survey.
Choosing the correct type of tray for all types of instrumentation, procedures, and sterilization methods will save money in the long run.
In my view instrument repair and replacement costs can keep going up with trays that are not evaluated to separate
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* Emily Walker Stockert, MBA, Alexander Langerman, MD, FACS, 2014Assessing the Magnitude and Costs ofIntraoperative Inefficiencies Attributable to Surgical Instrument Trays
Pick the Right Trayfor the Right Reason
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Size and weight of
the instrumentation
Sterilization method
and size of chamber
Purchase as a whole
tray i.e. lid and insert
sold separately
Support for Protecting Instrumentation are Found in ST79:2017
For using:
Instruments and tray liners
Sections 8.2
Tip protectors
Section 8.2
Stringers
Section 8.2
Education
Is essential
SPD and OR teams must
understand why you
protect instrumentation,
and why it must be
performed every time
Protection saves money in
the long run
It might increase your
budget, but it will reduce
your repair costs
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In Summary
Understand what you want to protect – you have many choices
Work with your customers and team
Work with your vendors/Reps
Teamwork will always work
This is only one piece of the protection process
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In Summary
Continued:
Properly maintaining surgical instruments during daily use is essential to keeping instrumentation in top working condition.
The utilization of instrument protection devices, and packaging aids can ensure the maximum utilization and extended life of costly surgical instrumentation.
The care of critical surgical instrumentation lies in the expert hands of the sterile processing technicians and surgical team.
Their attention to detail in following proper care and handling procedures will assure that safe and high-quality instrumentation are in the surgeon’s hands contributing to the best quality patient care outcomes.