On the brink: 3 dangers of inadequate surgical instrument reprocessing departments

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One of the most dangerous places to be in America is on an Operating Room table. The Leapfrog Group estimates that as many as 400,000 patients die every year due to preventable hospital errors.

And if that wasn't frightening enough, there are no hospital quality rankings that currently account for one of the most important quality-indicators for safe surgery: a high-performing surgical instrument reprocessing department.

These hospital departments handle the decontamination, inspection, assembly, packaging, sterilization, and distribution of every reusable surgical instrument, from aneurysm clips to suture scissors -- and one mistake there can have dangerous ripple effects along the entire continuum of surgical care. Here are three examples of how an inadequate reprocessing program can harm surgical patients:

1) When capital cleaning investment is ignored - instruments don't get clean
According to a recent report published in Infection Control & Hospital Epidemiology, surgical attachments for the popular minimally invasive robotic surgery are "virtually impossible to clean." This study highlighted what many inside the surgical instrument reprocessing industry have known for some time -- there is often a dangerous disconnect between the growing complexity of surgical instrumentation purchased in the OR and appropriate investment in the equipment necessary to safely and efficiently reprocess them for continued use. Without adequate cleaning tools, dangerous infections can be passed from one patient to another via contaminated surgical instruments.

2) When certification and continuing education is not present - safety is not valued
Currently there are only four states in the US who require industry certification for technicians working in surgical instrument reprocessing departments. For hospitals who do not require these certifications, there is a very real danger that facility-centered competencies will not meet accepted standards for best-practices for instrument cleaning, inspection, and sterilization. Technicians who are not familiar with the rigorous standards of the Association for the Advancement of Medical Instrumentation (AAMI) and other similar organizations are setting themselves, their facilities, and their patients up for a dangerous safety oversight. The work product of these technicians has direct contact with surgical patients, and without requiring certification and continuing education of these teams, facilities signal that surgical patient safety is not their top priority.

3) When inspection and preventative maintenance is disregarded - instruments don't work
Even the best surgical safety checklist and hand hygiene program cannot protect against a non-functioning surgical instrument that made its way into the Operating Room. Surgical clamps with cracked hinges can not only cause dangerous complications intraoperatively, but they can also harbor deadly infections such as MRSA and C. Diff, delivering them directly into the surgical incision. Cracked needle holder jaws can fall off into open cavities leading to a myriad of complications from retained foreign bodies (RFBs) and extended anesthesia times. Compromised insulation on laparoscopic graspers can cause deadly surgical burns to internal organs and surgical fires. When instrument technicians are not properly trained and equipped to appropriately inspect each surgical instrument, or when facilities do not have a comprehensive instrument repair program in place, patients are unnecessarily put at risk for instrument-related complications.

While these dangers can impact countless hospitals across the country, high-performing surgical instrument reprocessing departments do exist, and they do drive excellence across the entirety of a facility's surgical services. With appropriate capital equipment investment in these departments (particularly in regards to complex surgical instrumentation), mandatory industry certification, and comprehensive instrument inspection/repair programs, hospitals can ensure their surgical patients receive the safest possible care -- every surgery, every time. Safe surgeries can only happen with safe surgical instruments.

Weston "Hank" Balch is the Director of Sterile Processing Operations at University Health System in San Antonio, Texas and the President of the South Texas Association of Sterile Processing Services (STASPS). His department was named the "2016 SPD Department of the Year" by Healthcare Purchasing news, and his articles have been published in Infection Control Today and AAMI News, as well as over 75 LinkedIn Pulse articles that feature creative solutions and novel approaches to relevant topics in the world of Sterile Processing.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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