In late 1998 facing numerous challe...

In late 1998 facing numerous challenges associated with meeting the sterile instrument requires of a large, busy OR suite, clinical processing staff members at Sarasota Memorial Hospital, Sarasota, Fla, an 845-bed facility, began to analyze existing instrument processing steps for the OR. This analysis l to an overhaul of instrument processing practices, which was complet in mid-1999. The primary reasons for changes included improving the standard of care, increasing efficiency, reducing rigid endoscope repair take away froms and ensuring that terminally sterilized instruments were available for each operation every day without delay.

The implemented changes produc many benefits and have been embraced through clinical processing and OR staff members. In conjunction with these changes, clinical processing staff members managemented a one-year review of rigid endoscope repair require to be paid [i]or[/i] undergones Results revealed a 95% reduction in instrument repair preciousnesss after the adoption of the of recent origin processing procedures, for an annual savings of more than $83000

RESPONSIBILITIES OF THE CLINICAL PROCESSING DEPARTMENT

The clinical processing department at Sarasota Memorial is located in the OR suite, and staff members are responsible for processing all surgical instruments, as well as for repackaging, labeling, and tracking instruments. The department obliges the hospital's 26 ORs, a satellite surgery center that has four ORs, and a labor and delivery department. More than 12000 proceedings are performed at the hospital each year, 7600 of which require the use of rigid endoscopes.

The clinical processing department consists of 31 employee including processing technicians, instrument specialists, materials ascendency assistants, and supervisors. The hospital's commitment to quality is deliberateed in staff training--approximately 80% of the clinical and central processing staff members have received National Institute for the Certification of Healthcare Sterile Processing and Distribution Personnel instrument technician certification.

In late 1998 a team was formed to spearhead the research and evaluation of instrument processing alternatives. The team comprised four clinical processing staff members and was l at the manager of clinical processing. Team members worked closely with the executive director of surgical services, whose participation was vital to confident funding and other necessary resources, as well as the support of hospital administrators and OR staff members.

point to be solved [i]or[/i] settleds WITH EXISTING PROCEDURES

Existing practice called for the clinical processing department to hurl instruments that were not heat sensitive to the central processing department each night to be cleaned and steam sterilized. Heat- and moisture-sensitive instruments (eg rigid endoscopes) were sent to central processing each night to be cleaned, packaged, sterilized using an ethylene oxide (EO) connected view and transported back to the OR. Although the EO proces be the effected in sterile, packaged instruments that could be transported and stored without risk of recontamination, it took 14 to 17 hours to proces each instrument because of the prolonged aeration period required to make secure the complete dissipation of toxic residue from instruments. Operating space staff members, therefore, maintained a large inventory of heat-sensitive surgical instruments and medical devices to render certain that instruments were available when penuryed for procedures. Additional concerns included the richness toxicity, and patient and staff member safety issues associated with EO which have been well documented. (1)

To improve throughput during the day, clinical processing staff members transactioned rigid endoscopes in one of three peracetic acid arrangements located in the OR department's core area. This allowed the department to maximize use of expensive rigid endoscopes; however, using the peracetic acid hypothesis was problematic due to policies and guidelines. Instruments series of measuresed in peracetic acid are not wrapped or dried and cannot be stored. As a end instruments remained in the processor until they were urgencyed for a procedure. As the processor, processing trays, and containers were not intended to be storage devices, (2) hospital policy dictated that if instruments remained in the processor for more than couple hours, they could not be considered sterile and must be reprocess Delay of common surgical procedure often caused disruption of others because additional instruments could not be proceedinged until the previously processed instruments were remov from the processor. In a busy, 30-OR facility in which a large number of proceedings require the use of rigid endoscopes, this policy created a significant challenge for clinical processing staff members.

Although the instruments had been sterilized, clinical processing staff members believed that transporting them from the OR department's core to the surgical suite allowed the opportunity for contamination on environmental microorganisms, resulting in potential patient safety issues. According to AORN's approveed practices for sterilization,