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Archive January 2018 XIX, No. 1

Infection Prevention: Can Your Instrument Program Pass This Test?

You should be able to answer "yes" to these 5 questions.

Weston "Hank" Balch

Weston "Hank" Balch, CRCST, CIS, CHL


OR Instruments
QUALITY INDICATORThe quality of your facility's surgical instrument program is one of the most important — and most often overlooked — aspects of safe and efficient surgical care.

Functional, available and sterile instruments are critical to a safe and efficient surgical facility. Can you get a perfect score in this 5-question assessment of your instrument program?

1 Are your sterile reprocessing technicians certified?
Most facility personnel who reprocess every instrument, from cranial drills to minimally invasive cauterizing clamps, are often only required to have a GED to qualify for the role. But if you don't require your technicians to attend a certification program, you can't be sure of what baseline knowledge they have that's necessary to ensure safe surgical instrumentation in the role (such as basic microbiology, regulatory standards and documentation).
2 Do you have a strong preventative maintenance and repair program in place for your surgical instruments?
Most patients never consider that the scissors, clamps and retractors being used on them have been used on other people many times before. So it's your team's job to make sure that equipment is as safe as possible. Reusable surgical instruments have a limited lifespan and must be maintained, repaired and removed in accordance with strict manufacturer specifications to ensure that no subpar instrumentation reaches your patients. If you don't, any number of intraoperative instrument failures can occur, which can cause cross-contamination, surgical burns, retained foreign bodies or dangerous delays.
3 Does your facility have the proper tools and instrument models to allow for adequate inspection during reprocessing?
With the growing complexity of surgical instrumentation comes the need for critical inspection tools, such as flexible inspection scopes for orthopedic shavers, desktop magnification for micro-eye instrumentation and protein detection systems to pinpoint residual bioburden before sterilization. If you're still using the first generation of instruments known as laparoscopic graspers and Kerrison rongeurs, it's time to replace them. Unlike today's newer models, those older instruments can't be taken apart or flushed properly during the decontamination phase.
4 Is there sufficient instrument inventory to support your facility's surgical volume?
Due to the competitive financial realities of American healthcare, many facilities seek to manage their operating room schedules at an ever-growing capacity, but they're sometimes not proactive in investing in the capital funds necessary to purchase sufficient levels of instrument inventory. For a patient, this means the instruments needed for their case may have to be rapidly "turned over" from a previous surgery, which could lead to not only inadequate inspection by sterile processing staff, but also delayed surgery schedules and extended time under anesthesia. There are many services already available that enable them to capture big data points to safely optimize their surgical inventory, as well as to use instrument-conflict-checking through their preference card and scheduling system.
5 Do surgical implant vendor reps comply with your facility's instrument policies?
Whether the surgical procedure is repairing a complex fracture from a traumatic car accident or a scheduled spinal fusion surgery, vendors who sell the surgical implants necessary for the procedure will provide much of the instrumentation. Because this instrumentation is often not facility-owned, it is imperative that all quality processing and inspection standards are met to properly prepare them for surgery. This includes requiring adequate delivery timelines for instrument processing (typically 48 hours prior to the surgical procedure), manufacturer's instructions for use and FDA-approved packaging methods. Vendor instruments delivered late or with incomplete documentation can be a root cause for a number of preventable serious safety events in the operating room.
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