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

Why talk about this topic?

SURGICAL INSTRUMENTS ARE

ONE OF THE LARGEST DOLLAR

ASSETS OF A HOSPITAL

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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Inspection of

Instrumentation:

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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 support the practice of Inspection with enhanced visual inspection tools

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

Survey Question 6

How many of you have instrument trays that are overly crowded?

Many Types of Traysto Choose From

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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.

Thank youH

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