OutpatientSurgery

www outpatientsurgery.net

RMagazineMarch 2012

How do your site-marking protocols compareto the 560 surgicalfacilities we surveyed? P. 26

7 Great Ideas That Work p. 8

Definitive Guide toHand Hygiene p. 42

Protect Your OnlineReputation p. 62

900 Instrument Trays... Per Day p. 84

SiteRight

EXCLUSIVE SITE-MARKING SURVEY

SiteRight

MarkMarkthethe

How do your site-marking protocols compareto the 560 surgicalfacilities we surveyed?

OS_1203_Cover-OK_Layout 1 3/26/12 8:54 AM Page 1

You think you process a lot of instruments atyour facility? Hoes does 900 trays of surgicalinstruments per day sound? That’s the daily

output here at theHospital for SpecialSurgery, the oldest(founded in 1863) andbusiest orthopedic hos-pital in the UnitedStates, hosting moreorthopedic surgeries(25,000-plus) than anyhospital in the world.Incredible productivity,yes, but the sheer vol-ume of trays was put-

ting a tremendousstrain on our process-ing department.

We had the capacityto reprocess 750 traysof instruments per day,but were doing about150 more on top of that,including a record num-

ber of highly advanced loaner trays. That’s what hap-pens when you serve 27 operating rooms that areregularly scheduled into the evening hours.

To ease the burdenin the short term, werelocated the process-ing unit to a largerspace in the facility andadded lots of equip-ment: 7 automatedinstrument washers, 5floor-loading pre-vacu-um steam sterilizers, 2smaller steam units and3 low-temperature gasplasma sterilization

How Do You Process 900 Trays of Instruments Per Day?The country’s busiest orthopedic hospital revampedits sterile processing department to keep up withincredible demand.

Louis A. Shapiro, FACHE, and Stephanie J. Goldberg, RN, MSN, NEA-BC

INFECTION PREVENTION

FOCUSED FACTORY U.S. News and World Report ranked New York City’s Hospital for Special Surgery (below) the No. 1 hospital in thecountry for orthopedics in 2010. The hospital reprocesses 900 trays of instruments per day.

OS_1203_InfectionPrevention-OK_Layout 1 3/26/12 8:52 AM Page 84

units. We configured the new space with 13 employ-ee workstations, and included dedicated space forcase cart preparation and sterile storage for instru-ment trays and soft goods. We also invested in anautomated instrument management system andhired an experienced logistics manager.

Guess what? It still wasn’t enough. Even thoughwe enlarged the space and increased resources, weknew that we had to make additional structure andprocess changes to meet the increased instrumentdemands and to better support the operating roomsin the delivery of patient care.

We revamped our entire sterile processingprocess and department. We elected to view ourcentral sterile processing function as a reprocessingfactory. We audited and evaluated all aspects of thedepartment, including management, staffing, quality,workflow, processes, inventory and end products.We realized that the project would benefit fromadditional expertise to ensure a thorough and com-plete solution, and sought a consulting providerwith a holistic approach to sterile processingimprovement. Here’s a rundown of the processimprovement initiative.

Personnel changesAs customer expectations and surgical tray volumegrew, the existing CSP organizational structureneeded to change. We reviewed and revised theroles and responsibilities for each CSP position toreflect expected practice. We developed new jobdescriptions that specified accountabilities. Weoverhauled the system for career advancement, giv-ing CSP staff more opportunities for advancementwithin the department.

We also consolidated staff scheduling and workstart times to maximize staff during periods of highvolume. This analysis of workload distribution result-ed in a reduction of shift start times from 19 to 5,which has resulted in efficiencies in scheduling andbetter shift coverage. Finally, we hired a CSP educator,who established educational needs and competencies.

Process changesTo reduce the volume of instruments and trays com-ing through CSP, we streamlined surgical case traysand individual instrument trays. We also targeted

RE P R I N T E D F RO M OU T PAT I E N T SU RG E RY MAG A Z I N E | MARCH 2012

Perhaps the surest sign that we’ve succeeded inoverhauling our sterile processing department isthat we now hear positive feedback from our

techs. They tell us that they now feel good about comingto work. They were pleased that hospital leaders werelistening and providing meaningful resources and sup-port. Theyhad newcertifica-tion, educa-tion andleadershipopportuni-ties, andthereforefelt morevalued.They com-mented thatstaff sched-uling wasbetter forthem andfor the department. They were also glad to be improvingtheir relationship with the surgical department. Overall,morale improved greatly throughout the department, andthe culture began to shift towards a greater sense ofprofessionalism.

“Things have improved dramatically since the imple-mentation of the process improvements,” says Nilda Rios,central sterile technician. “The bar has been raised for thestaff. We work better as a team with the same goals anddeliver the best service to our patients and customers.”

With our new reprocessing “factory” and quality sys-tem in place, we have ensured optimal surgical schedul-ing capacity for current needs, but are also positioned forplanned future surgical innovation and growth. Moreimportantly, we have an engaged, educated and motivat-ed sterile processing team that is able to advance with us.

— Louis A. Shapiro, FACHE, and Stephanie J. Goldberg, RN, MSN, NEA-BC

HAPPY STAFF

Beyond the Expected: The Human Benefits

PRIDE IN THEIR STRIDE Do your CSP techsfeel good about coming to work?

Photos courtesy of SterilTek, Inc., a subsidiary of Steris Corp.

INFECTION PREVENTION

OS_1203_InfectionPrevention-OK_Layout 1 3/26/12 8:52 AM Page 85

the process for loaner trays (trays provided by out-side vendors) for improvement. We established adesignated loaner room and developed vendor per-formance metrics to ensure standardized processes.

We improved staff education on correct methodsfor decontamination, instrument inspection, trayassembly, sterilization, and the care and handling ofsterile supplies. We launched a massive CSP unitcleanup involving both operating room and CSPstaff. The objective was to remove any instrumentsnot being used and to organize the backup instru-ment inventory in CSP to make it easier for staff tofind the instruments they needed to complete trays.We established a process to replenish the backupinstrument inventory to par levels, which includedallotting space for vendor-specific items.

Along with backup inventory locations, we insti-tuted an instrument collection system at eachassembly station. Here’s how it works. As instru-ment trays pass through the assembly area, we col-lect extras or instruments that don’t belong in thetrays at each workstation and return them to themain storage locations. This also helps ensure thatstaff has backup supply to complete other trays.

We put into place a system for collecting feed-back to ensure there is quantitative data to use tomeasure the effect of the improved processes. For

example, there is now a method of reporting instru-ment trays that are returned to CSP with sharps orimproperly arranged instruments.

Measures of successHow’d we do? A key performance indicator hasbeen the decrease in the number of trays with miss-ing instruments. Over a 6-month period, we’ve seenan 18% reduction in missing instruments. In addi-tion, feedback from all 3 surgical floors about CSPservice has been much more positive.

Educational advancement is another valuableeffectiveness indicator. Improvements in education-al support toward certification have resulted in 60%of the CSP staff attaining a certification in centralservice (Certified Registered Central ServiceTechnician or Central Supply ProcessingDepartment Technician). Additionally, 16% haveobtained certification as an instrument specialist(CIS) and 4% have obtained a certification in health-care leadership (CHL). It is estimated that another20 staff members will obtain certifications withinthe next 6 months. OSM

Mr. Shapiro (shapirol@hss.edu) is president and chief executiveofficer of and Ms. Goldberg (goldbergs@hss.edu) is the seniorvice president and chief nursing officer for the Hospital forSpecial Surgery in New York, N.Y.

INFECTION PREVENTION

BEYOND PROCESS IMPROVEMENT No longer overwhelmed, the sterileprocessing staff now delivers better service to the 27 ORs it serves.

OS_1203_InfectionPrevention-OK_Layout 1 3/26/12 8:52 AM Page 86