North Memorial Medical Center in Robbinsdale, Minn., recently started seeing an increased volume of higher-acuity patients in its operating room, putting an immediate strain on the hospital's sterile processing department. To keep up with the rising demand while maintaining adherence to sterilization protocols, hospital executives knew something had to change.
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The cause of the increased demand was twofold. First, North Memorial Medical Center centralized the instrumentation of all the trays in the system, including outpatient and clinic instrument trays, to its hospital location. This dramatically increased demand on the hospital's sterile processing department very rapidly.
Additionally, per the post-Affordable Care Act trend of sicker patients seeking medical care now that they have insurance, this hospital has seen a higher volume of more acutely ill patients, thus making the instrument sets needed for surgeries more complicated, according to Uggen Jigmey, the hospital's sterile processing department manager.
He says demand in his department increased 15 percent since 2015. In addition to keeping up with climbing demand, the department is still required to turn the instruments out in a safe and timely matter.
The North Memorial Medical Center infection control team had generally turned to immediate-use steam sterilization, or "flash" sterilization, to sterilize surgical instruments when in a time crunch. However, studies have shown that while IUSS allows for quicker tray turnover, it isn't ideal for infection prevention. Guidance from CMS published in 2014 says IUSS has been "implicated in surgical site infections and [is] considered to pose an increased risk of complications because of potential barriers to thorough completion of all necessary reprocessing steps."
The document continues, "Therefore use of IUSS, even when all steps are performed properly, should be limited to situations in which there is an urgent need and insufficient time to process an instrument by using terminal sterilization."
Given this information, the infection prevention team at North Memorial Medical Center knew it had to move away from IUSS.
"We knew we wanted to do something about it, to reduce the number of times we used IUSS," said Stephanie Swanson, infection prevention manager at the hospital. "We want all instruments terminally sterilized... There are a lot of factors for patients getting infections that we can't control, but this one we can."
An All-Encompassing Solution
Administrators at North Memorial Medical Center found the solution to both the increased demand for sterile processing and the focus on decreasing IUSS use in the One Tray system.
The One Tray system is manufactured and distributed throughout the world exclusively by Innovative Sterilization Technologies. The sterilization system includes a rigid container with patented design features and processing kits that include the proprietary filters. The tray design combined with the proprietary filters allows surgical assets to be terminally sterilized much faster than with any other rigid container or wraps. In fact, One Tray has been validated for zero minutes of minimum dry/cool time, thus radically shortening the time needed to safely sterilize a tray.
The Implementation Process
North Memorial Medical Center has a phased implementation plan. Currently, the hospital uses the One Tray system for trays needed on the next case and on loaner trays because it allows for faster turnover. Further down the line, One Tray will eventually be used on all surgical assets that can be processed in a rigid container. The hospital began the implementation plan March 1, 2016.
Change doesn't always come easy, but thorough education eases the process, as North Memorial Medical Center found to be true when introducing One Tray to front-line staff.
The biggest change, according to Mr. Jigmey and Ms. Swanson, involves residual water in the tray at the end of the sterilization cycle. When wraps are used, no water should be present if a tray is properly sterilized, but with One Tray, moisture in the tray is a normal part of the process. This idea represented the undoing of years of education for the front-line members of the OR staff. Something that was once a cause for concern or correction — water in the tray — is now an acceptable effect from the One Tray system.
"It's a total mindset change for them. That's where the challenge lies," Ms. Swanson says. "It goes against what they believed to be sterile technique... It's a change in technology, so [we had to] get them up to speed on [how those changes] allow us to have better patient safety."
To assuage front-line workers' anxiety about the moisture retained in the One Tray system, North Memorial ran its own tests by culturing a sterilized tray that had moisture and "found no living organisms," Mr. Jigmey says. This finding complemented independent validation testing, which validated the system and allowed it to achieve 510(k) clearance from the U.S. Food and Drug Administration.
To ease the implementation and education process, One Tray's customer relations and education team spent five days at North Memorial training the OR and sterile processing staff, Mr. Jigmey says. In fact, for the first three days of One Tray use, Mr. Jigmey and members of One Tray's CRE team stayed in the OR to communicate directly with OR staffers and quell fears of water left in the tray.
Besides the front-line workers in the OR, the sterile processing department staff "loved" the system "because it saved us a lot of time and headaches [now that] we don't have to worry about wrapping," Mr. Jigmey says. From January to August of this year, North Memorial's sterile processing department recorded 39 punctured tray wrappers. With One Tray, punctures are impossible since the trays replace wraps.
Mr. Jigmey also notes One Tray is increasingly favored among surgeons at the hospital. "They know they're getting a better product for their patient" because it's eliminating the use of immediate use steam sterilization, he says.
Results and the Future
North Memorial adopted One Tray to improve efficiencies in the face of increased OR demand and improve patient safety. Although the hospital is still in the midst of the implementation process, it has already seen positive results on both fronts.
For instance, the entire sterilization process has sped up significantly. According to Mr. Jigmey, the new system allows the hospital to turn over trays three times faster than before.
Not only that, but One Tray has saved North Memorial Medical Center thousands of dollars per month on wraps alone, not to mention savings achieved by reducing the number of loaner trays required. For a specific hip procedure, for example, "we no longer need a loaner to come in [because] we're able to process them much faster," Mr. Jigmey says.
The sterile processing department has also gained roughly three hours of saved labor per day through the use of One Tray.
Most importantly, patients are safer because of the decreased use of IUSS at North Memorial Medical Center. Mr. Jigmey says IUSS has already decreased 30 percent, and by the time the One Tray system is fully implemented, "it will be zero," he says.
Down the line, Mr. Jigmey envisions the OR being able to schedule more cases per day with the saved efficiencies. "We're not there yet," he says, but once One Tray is fully implemented and optimized, "we'll be able to schedule more [cases] or at least turn around the instruments much quicker and [also] cut down on the purchase of [additional] instruments."