How improving sterile supply management in the OR can reduce infections and readmissions

[This content is sponsored by Surgical Directions]

Improving sterile supply management is one way hospitals can reduce the risk of infections and infection-related readmissions for their patients.

Hospitals and other healthcare facilities may have hundreds or thousands of different kinds of sterile products and implants in inventory— such as total joint implants, laparoscopic and open stapler devices, intraocular lens implants, disposable endomechanical devices, dressing, suture, needles, syringes, biological products and multiple other disposables — at any given time. Ensuring the integrity of these products is vital to preventing infections in patients and reducing readmissions.

Barbara McClenathan, RN, BSN, MBA, CNOR senior nurse specialist for perioperative consulting firm Surgical Directions, highlighted key concerns of ensuring product sterility: bioburden, product integrity, expiration, dust, debris, temperature and humidity.

"Bioburden is living, microbial load that may be a result of cross contamination or aerosolization and that may reside on the exterior of sterile disposable products," said Ms. McClenathan. "Managing sterile supplies to prevent bioburden contamination is extremely important to preventing infections."

There are three areas of supply management that hospitals and other healthcare facilities must focus on to ensure products remain sterile and free of contaminates, according to Ms. McClenathan. They include:

1. Manufacturer defined product sterility. There are two ways product sterility can be compromised, including:

  • Event-related sterility. Product integrity can be compromised due to some specific event (i.e. it was exposed to moisture, had its packaging torn, crushed, etc.); or
  • Expiration date. The product has passed its manufacturer-designated expiration date. Workers should be sure to check product expiration dates and the integrity of the packaging before using them on patients. Products should also be rotated so that the oldest products that have not yet expired are used before newer products.

2. Product storage. If a product is not stored appropriately, it may no longer be considered sterile. For instance, sterile products storage must follow manufacturer and regulatory agency recommendations. This includes being stored in a place at the right temperature, right humidity level, appropriate air flow direction and number of air exchanges per hour. Traffic should be limited and workers should be wearing the appropriate attire to be in sterile storage areas near supplies.

Ensuring appropriate sterile product shelving is also crucial. Shelves shouldn't be near windows, doors, sinks, vents or pipes, and bottom shelves should be covered to keep out dirt and dust. Additionally, sterile products should be immediately removed from outside shipping boxes that may be contaminated with debris, insects, fungi or bacteria.

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3. Cross-contamination in the OR. In the OR, products should be kept in a closed container during a surgical procedure and transported while covered to prevent aerosolized bioburden contamination. Nurses and OR staff should also be sure to check whether products can be dropped on the sterile field or must be opened by a circulating nurse and handed directly to the scrub technician.

"Compliance failures in any one of these three areas significantly increase the risk of infection and readmission for patients," said Ms. McClenathan.

Improving sterile supply management is a goal that staff at any level of the hospital can achieve.

For instance, hospital executives can:

  • Support capital needs for providing an appropriate environment to house supplies
  • Endorse supply procurement and purchasing initiatives such as Kanban or perpetual ordering systems, to increase product turns and support product integrity
  • Back the continuous improvement work of the infection control director and OR director

Surgeons can:

  • Maintain cost awareness among other staff members
  • Use up all existing product stock before switching to a new brand and eliminate the mindset of keeping old or obsolete sterile products around "just in case"
  • Find a surgeon champion who can collaborate with other surgeons to standardize the types of products used, decreasing inventory that can potentially be contaminated

OR staff members can:

  • Work to reduce the handling of products, often referred to as "touch-points" by updating preference cards at a minimum annually, and even bi-annually if possible, and removing products from preference cards than haven't been used during the past twelve months or an agreed upon span of time
  • Make sure products are always covered and contained interoperatively
  • Bring as few products in the OR as possible and transition from the mindset of picking products that may be needed "just in case" to the mindset of leaving products that can be picked, if needed, "just in time"

Implementing tactics like the ones above takes time and is always challenging. It may be more difficult in smaller, stand-alone hospitals that are not part of a larger system, where surgeons or clinicians may threaten to leave if they find the rules disagreeable. In larger health systems there tends to be more tolerance of these necessary processes, according to Ms. McClenathan. Still, the goal of improving sterile supply management is an important one for all hospitals looking to reduce infections and readmission.

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