by Elizabeth Hofheinz, M.P.H., M.Ed.
Thanks to Covid-19, there has likely never been a higher level of awareness of the bioburden in America’s hospitals. And, when we do come out on the other end of this crisis, patients will be keeping an eye on hospitals. They are going to be seeking out the facilities that do their utmost to provide a sterile environment for patient care.
One healthcare group that is ahead of the bioburden curve is Centura Health, a 17-facility entity serving Colorado and western Kansas. They are doing it via meticulous planning and a novel program called Surgio Health, a simple and robust software solution for the management and quality assurance in sterile processing departments (SPDs). 
Daniel Whetten, Supply Chain Manager at Centura Health, states, “This era of surgical downtime is the ideal moment for SPDs to refine their processes and prepare for the reopening of elective cases. Instead of furloughing SPD staff, hospitals can have them engage in thoughtful planning so that they can approach cases in a methodical manner instead of always putting out fires.”
Control…at a time when much feels out of control…
Chris Stewart, CEO of Surgio Health, states, “Like the rest of us, hospital administrations are feeling significant pressure these days. The immediate impact Surgio provides is a sense of control over SPD processes and vendor interaction with your facility…and that extends to a heightened sense of control over patient safety. Since elective surgeries have slowed or have been canceled due to COVID-19, this is the perfect opportunity for SPDs to address ways to improve on departmental processes, workflows and procedures. Vendors dropping off dirty and incomplete instrument sets, SPD staff rushing through the decontamination, cleaning and sterilization process because the OR calls and needs instrument tray’s ASAP…all of that can become a thing of the past with Surgio’s suite of interdepartmental solutions.”
While there are numerous healthcare workers on the front lines of the Covid-19 battle, those who are always on the front lines of infection prevention are those who work in SPDs.
And if those individuals have a misstep, then patients suffer. Last year, one sterilization technician working Goshen Health in Indiana skipped one step in a multi-step cleaning process of surgical equipment. The result? More than 1,000 patients were potentially exposed to HIV or hepatitis. This was followed by…you guessed it…a lawsuit.1
The problem has become so grave in the past years that in 2014 ECR, an independent, nonprofit organization, added “Inadequate Reprocessing of Endoscopes and Surgical Instruments” to its list of Top 10 Patient Safety Concerns for Healthcare Organizations.2
And the Centers for Disease Control and Prevention notes, “Sterile processing failures can lead to surgical site infections, which have a 3% mortality rate and an associated annual cost of $3.3 billion.”3
Jeff Wertz, VP of Business Development at Surgio Health, explains, “Vendors are worried about keeping the surgeons happy and the sterile processing department can easily become an afterthought. But hospitals cannot afford such thinking. The costs of reprocessing, not to mention the cost of treating a surgical site infection, are very burdensome.”
Indeed.
A 2019 survey undertaken by The Association of Perioperative Registered Nurses (AORN) found that 47% of respondents estimated the per-case cost of instrument processing to be $600 to $1,000; 30% estimated the cost as lower than that (less than $600) and 23% as higher (more than $1,000). As for infections, 64% of respondents said that a superficial infection would likely cost $10,000 to $50,000; 50% said that treating a deep SSI would cost $51,000 to more than $100,000.”4
Dan Whetten: “Closely tracking the minutiae of daily vendor/SPD/OR interactions is going to greatly reduce our costs. Enhanced structure and organization lead to better communication, tighter processes, and predictable outcomes, all which contribute to cost avoidance.”
Locking arms and moving forward…
“Data coming into and out of an SPD is often riddled with problems that end up affecting clinical care,” says Whetten. “We are making use of this time and having OR staff work with SPD staff to improve on each of their respective ‘pieces’ of the care chain. Together, they are using Surgio to establish a strong foundation and to ‘lock arms’ as we face reopening surgical care.”
Whether it is ensuring that all the right surgical sets are properly grouped together or solving a shelving problem, now is the time for OR/SPD cooperation.
Dan Whetten: “We have SPD staff approaching OR staff saying, ‘What are your pain points and how can we partner with you?’ They are beginning to get a grasp of one another’s perspective. Not only that, but they are more deeply comprehending what happens in one department when the other department enacts some sort of change.”
Down with reactivity…
“You could say that both SPD and OR staff must live with a high degree of chaos,” says Chris Stewart. “Patients are being rolled into the OR for surgery or are being intubated…there is a palpable sense of urgency to get all of the instruments ready for the procedures. If you have 18 ORs that translates to 18 procedural sets at the same time. People must do a lot of prep work the day before…not to mention the add-on procedures and emergency cases that throw a wrench in workflow and interdepartmental communication.”
One person who lives this on a daily basis is Chris Allen, Sterile Processing Manager of Centura’s St. Francis Medical Center in Colorado Springs. “Surgio has been invaluable in reducing ‘noise’ in the system and has given us a solid sense of control of vendor interactions and trays. SPDs are constantly fighting off chaos. One issue is getting reliable data uploads. It is usually a headache to go through the process of verifying that you have the right item number, that the product pictures are there, and that the count sheets and data transferred over correctly. All of this is streamlined with Surgio.”
In Allen’s mind, the Surgio dashboard “shines.” “Let’s say that at 2pm or later over 100 vendor pans come in your door for the next day. How do you go through this entire cycle with each tray without cutting corners and maintaining patient safety? It is our job to deliver all of those trays to the OR when we are also working on 40-case day.”
No more ‘he said, she said’
Jeff Wertz: “Vendors occupy an ambiguous space in that various parties rely on them to have the correct inventory, but at times they are scapegoats. If they are not communicating well or are not following hospital policies (which often vary by facility – even those within the same IDN) then there can be a lot of finger pointing. In the event that there is a discrepancy between what the Surgeon, OR, vendor and SPD say, Surgio has all the data necessary to get the story straight.”
Wertz, a former medical device vendor, notes, “Some systems do not require a photograph of the instruments or tray each time it’s dropped off and just reference a ‘stock photo’ of one similar. I know from my own bad experience of spilling a tray in the transit between my trunk and the SPD, the contents of each tray can change quickly and easily. This is why chain-of-custody documentation is critical. With the Surgio software, vendors get the opportunity to document the condition of their tray(s) at dropoff by taking photos and acknowledging that they have inspected each tray for completeness and cleanliness. This increases vendor accountability for their role in the process, When the tray gets to the SPD staff, they get a similar opportunity to assess the instruments and document their own interaction.”
There was an instance where, during surgery, an OR tech discovered that an instrument was missing a critical component. They were concerned that the component was inside the patient, so they did an xray and were looking all over until the OR director logged into Surgio. They were able to pull up an image and verify that the piece had broken off before it was dropped off at the hospital.”
Reporting that creates accountability…
“Discovering the origin of the problem is made easier with this software,” says Chris Allen. “’Who was late, why, and is there a pattern?’ are all things that can be teased out with this software. Are our vendors being lazy or is our hospital policy unrealistic? Are there breakdowns in late add-on communication between the surgeon office, hospital schedulers, vendors, and SPD? All of these are questions we are now able to evaluate and improve with the data rather than anecdotal evidence.”
Dan Whetten: “With Surgio’s software, not only is the visibility of throughput much cleaner, but it is substantially easier to make adjustments for staff. From an operations standpoint I can immediately see live reports, count sheets, data transfers, etc. And I have all of the inventory right at my fingertips.”
Having the right tools matters most in an emergency. And now, with the ongoing Covid-19 crisis, Centura is embarking on an effort to sterilize masks for first responders. “We will be using a piece of SPD equipment that will allow us to run these loads without changes,” states Whetten. “We will be able to track the data and tie it back to loads that were run with the masks. Thus, if the FDA says, ‘We need to see your records’ we will have everything at the ready in a digital format.”
Chris Allen: “The Surgio platform is nimble and able to respond to what we need. In developing it with Centura, they did not just do an overlay of a computer program on top of what we were already doing. They forced us to take a step back and think, ‘If we can have the moon what would that look like?’”
It would look astronomical…like Centura.
References:
- https://www.usatoday.com/story/news/health/2019/11/25/indiana-goshen-hospital-potentially-exposes-1000-surgical-patients-hiv/4299399002/
- https://www.ecri.org/components/HRC/Pages/RMRep0414_Focus.aspx?PF=1?source=print
- https://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf
- https://www.infectioncontroltoday.com/healthcare-departments/clinical-and-economic-case-sterile-disposable-instruments-and-implants