An Enhanced Kaizen Event in a Sterile Processing Department of a Rural Hospital: A Case Study

Operating Rooms (ORs) generate the largest revenues and losses in a hospital. Without the prompt supply of sterile surgical trays from the Sterile Processing Department (SPD), the OR would not be able to perform surgeries to its busy schedule. Nevertheless, little emphasis has been brought in the medical literature to research on surgical instrument processing in the medical literature. The present study was done applies an Enhanced Kaizen Event (EKE) in the SPD of a rural hospital to identify sources of waste and minimize non-value-added steps in the SPD processes. The EKE consisted of three successive Plan-Do-Check-Act (PDCA) cycles, which focused on improvements at the departmental level first, then at an area level, and finally at the station level. The EKE yielded an improved streamlined workflow and a new design for the SPD layout, one of its areas, and a workstation. This paper aims at building a methodology, including identified steps. Results exhibited a 35% reduction in travel distance by the staff, eliminating non-value-added processes, reducing errors in the sterilization process, and eliminating cross-contamination for sterilized materials.

Adenosine Triphosphate-Bioluminescence Technology as an Adjunct Tool to Validate Cleanliness of Surgical Instruments

Perioperative and sterile processing department personnel commonly use visual inspection to validate surgical instrument cleanliness. This validation process does not detect microbes (eg, bacteria, viruses) and the resultant inadequately decontaminated instruments can put patients at risk for developing surgical site infections. Sterile processing department personnel should use a rapid, straightforward method to validate surgical instrument cleanliness objectively. During a quality improvement project at a military treatment facility, staff members found that adenosine triphosphate (ATP)-based technology was a viable and affordable solution for detecting bioburden and validating cleaning practices. The project design compared manually and mechanically cleaned cannulated instruments (59 of each) and identified 16 contaminated instruments, 14 of which had been manually cleaned. The contamination rate after mechanical cleaning was significantly lower (P = .0022) compared with manual cleaning. As a result of this quality improvement project, this facility fully implemented the technology to validate instrument cleaning.

Surgical Instrument Decontamination: A Multistep Process

Surgical instrument decontamination requires the collective input of facility leaders, OR staff members, and sterile processing department personnel. Individual accountability can ensure that instruments are cleaned according to the manufacturers' written instructions for use, appropriate regulations, and facility policies. Information about the instrument decontamination process-from point of use to sterilization-should help enable perioperative nurses to advocate for and participate in the appropriate implementation of the necessary process steps. Sterile processing department leaders should develop policies and procedures for decontamination of surgical instruments and devices and the various accountabilities for the process steps. They also should help provide education for their staff members and complete required documentation. This article reviews the steps of instrument cleaning and decontamination and provides a framework to help perioperative leaders and educators facilitate these steps in their work environments, prevent instrument damage, and help ensure safe patient care.

Integrating Fetal Therapy Procedures in an Established Labor and Delivery Service

Treating fetal disease in utero is a specialized aspect of obstetric medicine that continues to develop as new technology and better imaging techniques are introduced. Surgical interventions may improve outcomes in fetal diseases such as fetal anemia, spina bifida, and congenital diaphragmatic hernia; however, the addition of a dedicated fetal treatment center to an established busy labor and delivery unit requires facility resources and support. Fetal medicine and labor and delivery leaders can develop a successful fetal therapy service when they partner with fetal medicine specialists, obstetric providers, anesthesia professionals, nursing staff members, and sterile processing department members. By working together, multidisciplinary team members should be able to provide excellent and cost-effective collaborative care while maintaining patient safety. This article provides an overview of key components that should assist perioperative leaders when developing a successful fetal surgery program.

Harboring Contaminants in Repeatedly Reprocessed Pedicle Screws

STUDY DESIGN

It consisted of evaluation of the pedicle screws for presence of residual nonmicrobial contaminants and tabulation of the minimum steps and time required for reprocessing implants as per guidelines and its comparison with actual practice.

OBJECTIVE

An evaluation of the nonmicrobial contaminants prevalent on the pedicle screws used for spine surgery and the underlying practice cause behind the source.

METHODS

The first component consisted of a random selection of 6 pedicle screws and its assessment using optical microscopy, scanning electron microscopy with energy dispersive spectroscopy, and Fourier transform infrared spectroscopy. The second component consisted of review of implant reprocessing guidelines and its applicability.

RESULTS

Three types of contaminants were identified: corrosion, saccharide of unknown origin, and soap residue mixed with and were mostly present at the interfaces with low permeability. In addition, manufacturer's guideline recommends 19 hours of reprocessing, whereas the real-time observation revealed a turnaround time of 1 hour 17 minutes.

CONCLUSION

Repeatedly reprocessed pedicle screws host corrosion, carbohydrate, fat, and soap, which could be a cause of surgical site infection and inflammatory responses postsurgery. The cause behind it is the impracticality of repeated cleaning and inspection of such devices.