A tremendous number of articles and discussions have focused on the rapidly changing landscape of our healthcare delivery systems. The causes are numerous and have been thoroughly examined. The results are impacting healthcare professional and suppliers in a number of ways. For those of us who work with and in the Central Supply/Sterile Processing Area, one such example is the change in nature and locations of where complicated surgeries are performed. More and more of these procedures are performed away from the main institution in off-site clinics and Doctors Offices. The instrumentation used is often sophisticated and requires well-trained staff to clean and sterilize this expensive equipment. Combining this trend with the rapid consolidation of hospitals and physician practices and the development of integrated delivery systems has forced Sterile Processing Department to handle more locations’ instrumentation. This change demands the development of new answers. These solutions need to not only produce quality products but also meet Federal and Industry standards. Kaiser Health System has been on the forefront of many of these changes. They recently implemented Healthmark’s SST System and Carts to help them manage this process. We felt CS Professionals would find it an interesting and useful Case Study.

 

Case Study:                               THE SST SYSTEM

 

A container & cart solution for handling

contaminated reusable instrumentation.

 Facilities Examined: Kaiser Health System North including Kaiser Pointe West Clinic Kaiser Sacramento Hospital, Kaiser Roseville Clinic and Kaiser Roseville Hospital, and Kaiser Sacramento Labor & Delivery

 Following the decision to build two new satellite clinics which were away from their respective main hospital campuses, and after extensive planning, Kaiser elected to use a “central” Sterile Processing Unit in the hospital’s on the respective main campuses. These Units would serve to address and satisfy the needs of its’ satellite/off-campus facilities while maintaining the highest standards of hospital quality care guidelines. In developing methods of transporting instruments to and from facilities careful consideration was given to safety, reliability and containment. The Latched Container System (SST System & Carts) satisfies all these criteria and met the approval of CALOSHA standards for moving contaminated hazardous materials. Specifically CALOSHA mandated that a system be implemented that took into account road hazards including vehicle collisions that might jeopardize the integrity of the container. The Latched Container System (SST System & Carts) addressed these criteria by providing proper safeguards to accidental spills. 

Before the Kaiser committee charged with this responsibility could proceed, they needed to create a plan. First was to develop an outline: Describe the Challenge and Determine the Solution – Define the Process and Issues – Identify Government Rules – Review Infection Control Policies and Modify Cleaning Practices

 

Description of Challenge – Sterile Processing for Off-Site Surgical Facilities:

1.      Existing “off-site” locations had insufficient space for effective decontamination equipment

2.      New sites were designed without a Sterile Processing Area

3.      Budgetary concerns

4.      Under-utilized processing equipment at main hospital

5.      Limited staff

6.      Limited number of professional processing staff.

7.      Potential inconsistencies in cleaning & infection control practices through out facilities

8.      Lack of efficient decontamination & sterilization equipment

 

Solution:

A Centralized Sterile Processing Area

 

Define Process

Next the committee spent considerable time defining the logistical flow the instruments would encounter. A list of issues was developed. Then each item was addressed. Many procedures were already in place but a number required further refinement with the appropriate responsible individuals (i.e. Transportation/Security) 

List of Logistical Issues

  1. Safety – Great concern was given to employee, patient, community and environmental safety.
  2. Transportation – Distances, time and locations had to be identified and studied
  3. Transport Vehicle – It was determined that the main hospital would deliver a number of items to the off-site locations. Vehicle criteria had to be established i.e. size, ability to clean and ease of loading and unloading.
  4. Personnel – Who responsible for which area was defined
  5. Instrument loss & damage – A potientially contentious issue regarding responsibility and cause required a delicate but pragmatic solution.
  6. Delivery schedule Pickup & Return – Who’s available and what’s the ideal time.
  7. Need/desire to prevent gross tissue from drying
  8. The number of surgical cases and the volume of instruments were studied
  9. Features of Containers & Carts were listed to insure they would address all the safety and logistical concerns.

Containers

1.      Covered & Latched

2.      Spill resistant

3.      Marked with Hazardous Symbol

4.      3 parts – base, cover & basket

5.      Autoclavable Trays

6.      Compatible with enzymatic solutions

Carts

7.      Durable enough to withstand constant transportation

8.      Cart washable

9.      Carts are sealed & latched

 

CALOSHA

Kaiser referred to the Federal Bloodeborne Pathogen Guideline published December 6th, 1991 – Part II, 29 CFR Part 1910.1030 which was developed by OSHA and adopted by CALOSHA. Significant issues included: “ (1910.1030, (xiii)) Specimens of blood or other potentially infectious materials shall be placed in a container which prevents leakage during collection, handling, processing, storage, transport, or shipping.” (g)(7)(I) “Labels and signs” which refers to proper color and/or proper Biohazard printed on the container. (xiii)(B) “…the primary container shall be placed within a second container which prevents leakage during handling, processing, …”

The SST System and Carts were determined to meet all the issues raised for processing contaminated reusable instrumentation. 

Infection Control Issues

A policy was written as per Hospital protocol. It laid out the Purpose, Policy Statement, Organization and responsibilities, Monitoring of Services and Plan of Action. Copies of the policy are available by Contacting Healthmark Industries at 1-800-521-6224. Please refer to the Kaiser Permanente Policy Statement. 

Cleaning Products & Practices

SPD needed to identify the products that would make this process work. Many of these products were already in use and were easy to identify. However, many were not and sources needed to be contacted. General categories were developed and implemented

  1. Equipment required
  2. Enzymatic solution
  3. Kaiser Policy & Training

After Kaiser’s plan was completed. All the required products and supplies were purchased. Once the new facilities were operational the policy was successfully implemented. Due to its success a number of on-site departments were added to the list. Below is a general description of how the implemented policy flows.

 

Process:

Using the basic guidelines outlined above, a logistical process was developed which would meet the requirements of each surgical location and the servicing Sterile Processing Department. The policy had to be consistent for the best results.

 We will begin our examination at the point-of-use locations.  

After each case is completed the instruments receive a “quick clean” in an enzymatic soaking solution. While enzymatic solutions do not disinfect, they facilitate the removal of protienatious materials from the instruments. Delicate instrumentation is put in separate containers inside each SST System to prevent expensive damage and loss. Containers with dirty instruments are kept in the sealed transport carts. At the end of each day after all the cases are completed all but a small amount of the solution is removed from the SST containers using a drain port. The Carts with trays are loaded in a small delivery truck along with other dirty/used supplies (i.e. linens, etc.). Transportation/Security performs this task. The carts are durable, sealed, securely latched; cart washable, easy to clean, lightweight and fit into limited space available in each clinic.

Carts and other supplies are returned to the main facility (Kaiser Roseville Hospital for Roseville Clinic & Kaiser Sacramento for Point West Clinic), unloaded and delivered to Central Processing - Decontamination. The sealed latched trays are removed from the carts. The basket with instruments and separate base & cover are placed in the cleaning process. These “central” locations handle every instrument set following the same cleaning procedure. Items are reviewed, repackaged, and sterilized. Consistency, control and ultimately the quality of product produced are significantly better than before. In addition supporting documentation is more accurate and consistent. Carts are cleaned and reloaded with clean empty trays for return to the using site by 9 am. In addition to the SST Carts & Trays Transportation delivers other supplies and instrumentation required for the day’s cases. For onsite high volume locations this process is repeated every 4 hours.

 “Change or be changed” was the issue facing Kaiser personnel. The rapid increase in surgeries performed off-site required new and innovative answers. It required significant input from a number of areas including Infection Control, Sterile Processing (both current & the individuals taking over process, Transportation (Security), & Clinical Heads from each clinical site. The SST Carts & Trays helped Kaiser accomplish its goal of effectively implementing a Centralized Sterile Processing Area. It provides a safe, efficient and dedicated answer that meets the strict requirements of both Infection Control & CALOSHA.

We would like to especially thank the people involved. A tremendous amount of time and effort was put in to this project from a variety of individuals including but not limited to Bill Shovelton, Art Benidicto, Betty Goestch & Paul Whitten (SPD Manager for both servicing departments).